Tb hip full details for md exams 10 marks answer from this pdf only repeat
Reading File
Running Command
Here is the complete TB Hip - 10 Marks MD Exam Answer structured from the PDF:
TUBERCULOSIS OF HIP JOINT
DEFINITION & INCIDENCE
- 2nd most common site of osteoarticular TB after spine
- 15-20% of all osteoarticular TB cases
- Predominantly affects children; concurrent/prior pulmonary TB in ~50%
PATHOLOGY
Sites of initial focus (in order):
- Acetabular roof (most common)
- Femoral epiphysis
- Proximal femoral metaphysis
- Greater trochanter
- Rarely - synovial membrane
Sequence: Bone focus → granulation tissue → caseation → spreads to cartilage, synovium, capsule → cold abscess → perforation of capsule → sinus/intrapelvic abscess
Head and neck of femur are intracapsular → bony lesion here invades joint early; acetabular lesion invades joint late
CLINICAL FEATURES - THREE STAGES
| Feature | Stage I: Synovitis | Stage II: Early Arthritis | Stage III: Advanced Arthritis |
|---|---|---|---|
| Deformity | Flexion + Abduction + ER | Flexion + Adduction + IR | Flexion + Adduction + IR (severe) |
| Limb Length | Apparent lengthening | Apparent shortening (true ≤1 cm) | True shortening |
| Capsule | Distended by effusion | Fibrotic, contracting | Destroyed |
| Joint | Max capacity position | Damaged articular surface | Pathological dislocation |
Common symptoms (all stages):
- Pain in hip/thigh or referred to medial knee
- Limp, avoidance of weight bearing
- Night cries (muscle spasm relaxes during sleep)
- Muscle atrophy, restricted movements
RADIOLOGICAL CLASSIFICATION (7 Types - Bhan & Nag)
| Type | Feature | Prognosis |
|---|---|---|
| Normal | Mainly synovial; joint space preserved | Good |
| Perthes' | Sclerotic femoral head; children <5 yrs | Good |
| Dislocating | Subluxation/dislocation; capsular laxity | Good (open relocation) |
| Wandering acetabulum | Subchondral bone erosion | Poor |
| Protrusio acetabuli | Medial acetabular wall destroyed | Poor |
| Mortar & Pestle | Erosion of subchondral bone | Poor |
| Atrophic | Irregular femoral head; narrow joint space; adults only | Very poor → fibrous ankylosis |
- Normal/Perthes'/Dislocating → symptom duration 4-7 months
- Wandering/Protrusio/Mortar & Pestle → duration 10-14 months
INVESTIGATIONS
| Test | Finding |
|---|---|
| X-ray | Osteopenia → osteolytic focus → joint destruction |
| USG | Early soft tissue swelling, effusion |
| MRI | Best early imaging; 100% sensitivity, 88% specificity |
| Synovial fluid | Thick; high protein; lymphocytic; culture positive in most |
| Synovial biopsy | Caseating granuloma + Langhans giant cells - gold standard |
| CBNAAT (Xpert MTB/RIF) | Sensitivity 94.6%, specificity 85.3% in bone/joint tissue |
DIFFERENTIAL DIAGNOSIS
- Perthes' disease
- Septic arthritis
- Transient synovitis
- Rheumatoid arthritis
- CDH (Congenital Dislocation of Hip)
- Osteoarthritis
MANAGEMENT
1. Anti-TB Treatment
- 2HRZE / 10-16HRE (total 12-18 months; many orthopaedicians prefer 18-24 months)
- DOTS compliance mandatory
2. Skin Traction (all stages initially)
- Corrects deformity, relieves spasm, maintains joint space, prevents dislocation
- Abduction deformity → traction to both limbs
- Stages I & II: up to 12 weeks traction
3. Weight-Bearing Protocol
12 weeks traction → 12 weeks NWB with crutches → 12 weeks partial WB → unprotected WB
4. Surgery
| Stage/Condition | Procedure |
|---|---|
| Stage II | Partial synovectomy + curettage of osteolytic lesions ± cancellous bone graft |
| Stage III | Synovectomy + debridement → plaster spica 6-9 months → aim: fibrous ankylosis in functional position |
| Ankylosis in bad position | Corrective femoral osteotomy (above lesser trochanter) |
| After age 20, ankylosis needed | Arthrodesis - Hibb's (iliofemoral) or Britain's (ischiofemoral) |
| Painful hip, preserve ROM | Excision arthroplasty (Girdlestone) - excise head & neck; limb 2 cm short but patient can squat |
| Healed >5 years / selected active cases | Total Hip Arthroplasty (THA) |
5. Cold Abscess
- Drain promptly to prevent sinus formation
COMPLICATIONS
- Pathological dislocation
- Wandering acetabulum
- Cold abscess & sinuses
- Limb shortening (bone destruction + growth arrest)
- Secondary pyogenic infection
- Fibrous ankylosis in deformity
RAPID RECALL (Memory Aid)
- Stage I = FAb+ER (like resting position) → apparent long
- Stage II = FAd+IR (like antalgic guard) → apparent short
- Stage III = same + true shortening + dislocation
- MRI = best early imaging
- Biopsy = gold standard
- CBNAAT = rapid molecular diagnosis
Source: Sharma & Mohan, Textbook of TB, 3rd Ed., Chapter 19 (Bhan & Nag); Harrison's 22e
This is a shared conversation. Sign in to Orris to start your own chat.