Tuberculosis is a common infection that can involve bones and joints. The spine is the most common site affected, accounting for about 50% of cases. Symptoms include constitutional symptoms like fever as well as localized pain, stiffness, and deformity. Diagnosis involves imaging like x-rays, CT, or MRI as well as tests like tuberculin skin tests or sputum/synovial fluid analysis. Treatment involves chemotherapy and sometimes surgery to treat deformities, abscesses, or neurological complications. The goal is to heal the infection and achieve a good functional outcome.

1. TUBERCULOSIS OF BONES AND
JOINTS
Dr. Deepak Tyagi , junior resident,
Dept of orthopaedics
MGIMS,SEVAGRAM

2. .Tuberculosis is still a common infection in developing
countries . After lung and lymph nodes ,bone and
joint is the next common site of tuberculosis .
.It constitutes about 1-4 percent of the total number
of cases of tuberculosis.
.The spine is the commonest site of bone and joint
tuberculosis ,consisting about 50 % of the total
number of cases .

3. Etiopathogenesis:
• Common causative organism is
Mycobacterium tuberculosis.
• Skipped lesion
• Disseminated skeletal tuberculosis
• Types- caseative exudative and granular
• Atypical mycobacterial tuberculosis( M.
Kansasi)– synovial sheath.
Implant tuberculosis
• Healing
• Drug resistant tuberculosis

4. Site of involvement
Spine>hip
>knee>elbow

7. Investigations:
• Roentgenogram and X ray
chest
• Blood
• Sputum examination
• Synovial fluid analysis
• Mantoux test/ Tuberculin
test
• Guinea pig inoculation
• Smear and culture
• Isotope Scintigraphy
• Serological investigation/
interferon
• Modern imaging technique
( ultrasonography,CT,MRI)

8. Clinical features :
• Constitutional Symptoms :
• Localised symptoms and
signs:
• High index of suspicion
• Fallacious H/O trauma

9. Management :
• General treatment
• Care of the affected part
• Role of steroids
• Chemotherapy/ prophylaxis
• Middle path regime
• Local treatment and role of surgery
• Operative intervention :

11. Operative intervention :
• Biopsy
• Treatment of cold abscess
• Curettage of the lesion
• Joint debridement
• Synovectomy
• Salvage operation
• Arthrodesis
• Joint replacement
• Decompression
• Osteotomy
• Amputation
• Ray resection
• excision

13. Tuberculosis of spine
Types
• Paradiscal
• Central
• Anterior
subperiosteal
• Appendiceal /Neural

14. Paradiscal

15. Central

16. Anterior/subperiosteal

17. Appendiceal/neural

18. Clinical features
• Pain
• Stiffness
• Cold abscess
• Paraplegia
• Deformity

19. Deformity

20. Cold abscess

21. Retropharyngeal abscess

22. Lumbar abscess

23. Thoracic abscess (bird nest
appearance) fusiform type

24. Classification

25. Causes of paraplegia in TB of the
spine

26. Operative treatment in TB spine
Absolute indications :
Paraplegia occurring during conservative treatment
Severe paraplegia
Paraplegia accompanied by uncontrolled spasticity
Relative indications:
Recurrent paraplegia
Paraplegia with onset in old age
Painful paraplegia
Rare indications:
Paraplegia due to posterior spinal disease
Spinal tumor syndrome
Severe paralysis secondary to the cervical disease
Severe cauda equina paralysis

27. TB HIP

28. Classification

29. Radiological features of TB hip

30. Radiological types of TB hip

31. Treatment-excisional arthroplasty

32. TB KNEE
Triple deformity of knee –valgus, external
rotation ,flexion deformity of knee with
posterior subluxation of tibia

33. Treatment-(charnley compression
arthrodesis )

34. TB ELBOW

35. TB SHOULDER (CARIES SICCA)
CARIES SICCA

36. TB Wrist
DER ,CAPITULUM,CARPAL DISSEMINATION

37. TB Ankle joint
TB Distal end of the tibia and malleolus and talus

38. TB Foot calcaneum ,subtalar ,
midtarsal and metatarsal
TB calcaneum TB metatarsal

39. TB of tarsals

40. TB Talus

41. TB short tubular bones( dactylitis)

42. TB Metacarpal

43. Tuberculosis of sacroiliac joint and
sacrum

44. TB of rare sites ,Girdle and flat bones
• Sternoclavicular joint
• Acromio-clavicular joint
• Clavicle
• Scapula
• Symphysis pubis

45. TB Scapula

46. TB Clavicle

47. TB Pubis symphysis

48. TB Sternum and Ribs

49. Tuberculous osteomyelitis without
joint involvement (spina ventosa)

50. Cystic tuberculosis of fibula

51. Tuberculosis of tendon sheath and
bursae

52. Tuberculosis of greater trochanter(
bursa)

53. Tuberculosis of facial and skull bones
• Not our domain

54. Take home message
TB infection of the bone and joint causes chronic
pain ,deformity, disability and life threatening
especially in tuberculosis of cervical spine, hence
the diagnosis should be made early by keeping the
high suspicion index so that early treatment can be
started with the aim of healing of the disease and
getting good functional outcome by chemotherapy
alone or along with the surgical intervention
.Regular follow up is mandatory to achieve good
result