Describe Tuberculosis of the Hip in detail.
Definition
Tuberculosis of the hip is, after the spine, one of the commonest sites of osteoarticular TB. It is a chronic granulomatous monoarticular infection that, untreated, progresses to destruction of the joint and fibrous ankylosis in a deformed position.
Clinical Stages & Features
Presentation is insidious, with a limp, pain (often referred to the knee), muscle wasting and night cries in children. The hip passes through recognised stages of apparent deformity: the stage of synovitis (early) holds the hip in flexion, abduction and external rotation (the position of greatest capacity); the stage of arthritis/destruction shifts it to flexion, adduction and internal rotation, producing apparent shortening. Constitutional TB symptoms are usually present.
Investigations & Management
Raised ESR, positive Mantoux, and radiographs showing juxta-articular osteoporosis, marginal erosions and reduced joint space; MRI shows early synovitis and abscesses; aspiration/biopsy confirms. Treatment is anti-tuberculous chemotherapy with rest and traction/splintage to relieve spasm and prevent deformity, then guarded mobilisation. A destroyed joint (once disease is quiescent) may need arthrodesis or arthroplasty.
CLINICAL PEARL
The early ‘FABER’ posture (flexion, abduction, external rotation) of the synovitic hip gives way to flexion, adduction and internal rotation as the joint is destroyed — a useful clinical marker of stage.
Complications
If diagnosis or treatment is delayed, the hip is progressively destroyed, leaving a stiff, painful, deformed joint with true shortening and fibrous ankylosis, sometimes with a wandering acetabulum (migration of the femoral head through an eroded acetabular floor), cold abscess or sinus. Even after cure, a badly damaged joint may need arthrodesis or, in suitable patients, arthroplasty once the disease is fully quiescent.
DANGER / REMEMBER
Reconstructive surgery (arthrodesis or arthroplasty) is undertaken only when the disease is quiescent after adequate chemotherapy — operating on an actively infected joint risks flaring the infection and implant failure.
Early stage shows apparent lengthening; later, true shortening.
KEY POINT
Key points TO remember
- Common osteoarticular TB; insidious limp, referred knee pain, night cries.
- Synovitis stage: flexion, abduction, external rotation → destruction: flexion, adduction, internal rotation.
- X-ray: juxta-articular osteoporosis + marginal erosion; confirm by biopsy/culture.
- ATT + rest/traction; arthrodesis or arthroplasty for a destroyed joint once quiescent.
EXAM TIP
Sources: Maheshwari's Essential Orthopaedics; Apley & Solomon's System of Orthopaedics and Trauma; AO Principles of Fracture Management.
All questions in Bone & Joint Infection
- Q1Define Acute Haematogenous Osteomyelitis. Describe its clinical features, investigations, management and complications. ★
- Q2Define Chronic Osteomyelitis. Describe its clinical features, investigations, management and complications. ★
- Q3Define Septic (Pyogenic) Arthritis. Describe its clinical features, investigations, management and complications. ★
- Q4Tuberculosis of the Spine ★
- Q5Define Tuberculosis of Bones & Joints. Describe its investigations, management and complications. ★
- SN1Write a short note on Sequestrum & Involucrum. ★
- SN2Define Brodie’s Abscess. Describe its clinical features, investigations, management and diagnosis.
- SN3Write a short note on Cold Abscess. ★
- SN4Septic Arthritis of the Hip in Children ★
- SN5Define Gas Gangrene. Describe its pathophysiology, clinical features and management.
- SN6Describe Tuberculosis of the Hip in detail.
- SN7Describe Cierny–Mader Classification in detail.