The second most common site of skeletal tuberculosis after the spine is the tuberculosis of hip joints (15% of the skeletal tuberculosis cases). When tuberculosis spread from the lungs to the hips in the human body, it is known as Hip Tuberculosis.
The initial infection may start in the
- Acetabular roof (most common)
- Greater trochanter (least common)
Causes of Hip Tuberculosis
Hip tuberculosis is caused when the infection spread to the hip region from the lungs. The lungs are the first region to be affected by tuberculosis which further gets transferred to other organs through blood vessels. Hip tuberculosis cannot be spread from person to person but lung tuberculosis can be spread by the exchange of blood and body fluids of the infected person.
Malnutrition, environmental conditions, and living standards such as poor sanitation, overcrowded housing, and slum dwellings are some factors that lead to Tuberculosis.
Symptoms of Hip Tuberculosis
Mostly affected children are between 5 to 15 years of age.
A painful limb is the most common and earliest symptom.
The patient starts to walk with a limp. The patient puts a little pressure over the affected side of the hip and walks with an antalgic gait.
The patients start to feel excessive pain in their hips, especially during nighttime.
Additionally, deformity, stiffness, shortening, and fullness around the hips can also be experienced by the patients.
Other symptoms like fever, weight loss, and loss of appetite can be seen.
On examination, tenderness may be present and the joints may be elicited down from their original position.
Stages of Hip Tuberculosis
The disease process progress through the following clinical stage:
- Stage 1 (Stage of Tubercular synovitis) -
Due to swelling & pain in the joints, there is joint effusion, which demands the hip to be in a position of maximum capacity, i.e. maximum flexion, abduction, and external rotation.
- Stage 2 (Stage of early arthritis) -
With the advancement of the disease process, articular cartilage is destroyed. In this stage, there is a sudden movement of the flexors which results in flexion, adduction, and internal rotation deformity. The space between the joints is reduced and can be seen in a diagnosis. Shortening starts to damage the cartilage and is less than 1 cm.
- Stage 3 (Stage of late arthritis) -
With further destruction, the limbs start to get reduced or shortened. Movement is restricted. Head, acetabulum, and cartilage are destroyed. The X-ray may show complete loss of joint space with the destruction of the head or acetabulum. True shortening is more than 1 cm.
- Stage 4 (Late arthritis with dislocation) -
With the destruction of the acetabulum, femur head, and ligaments, the upper end of the femur may be displaced upwards and dorsally leaving the lower part of the acetabulum empty. This can further lead to the destruction and dislocation of the femur head.
Diagnosis of Hip Tuberculosis
Diagnosis of children and adults is done separately to know the type and stage of hip tuberculosis.
In children –
Perthes Disease: It affects children of age group 4-8 years. The child may present with a painful limp. Clinically, the child may have limited abduction and internal rotation while in TB, all the range of motions is painful. MRI shows destruction of both the acetabulum and femoral head only.
Low-grade septic arthritis: Puss may be seen along with other symptoms.
In adults –
Osteoarthritis: Pain occurs in the hip joint. On X-ray, examination sclerosis may be present.
Monoarticular Rheumatoid Arthritis: this is a type of rare disease. The joint space in the hips is uniformly narrowed.
Treatment of Hip Tuberculosis
Tuberculosis of the hip is said to be active when the hip is extremely painful with the presence of fever, weight loss, and low appetite. On examination, there is a rise in local temperature, the hip is tender, and the range of motion is painful. The treatment provided to patients are:
Nonoperative Treatment: Patients are admitted and ATT (Anti-tubercular therapy) is started. The affected hip is put to rest by using skin or skeletal traction. Traction relieves spasms, reduces pain, prevents or corrects the deformity, and prevents dislocation of the hip. When the patient starts to experience less pain, some exercises are recommended.
Operative Treatment: If there is no adequate response to conservative therapy, the damaged tissue or bone is removed. In this, the joint is opened and pus, damaged tissues, inflamed synovium, and other dead tissues are removed.
Yes, when the bacteria from the lungs spread to other organs through blood vessels, it can affect any part of the body such as the brain, kidney, spine, etc. It can spread to the Hip joint which is the 2nd most common site of Bone tuberculosis.
Pain in the hip, limp, and restriction of movement are the first signs of hip Tuberculosis. Depending on the severity of the infection, the patients can further show the symptoms of deformity, shortening of the limb, swelling, and dislocation.
Hip TB cannot be spread directly through the air but TB of the lungs can be spread from one person to another. 3 ways to help prevent others from getting hip TB are:
- Take all your medicines timely as prescribed by doctors.
- Always cover up your mouth with a tissue or mask while you go out in public.
- Always wash up your hands before using anything.
Hip TB cannot be spread through the air gets get transferred through the exchange of blood or body fluids exchange. People with TB disease are most likely to spread the bacteria to people they spend time with every day, such as family members, friends, coworkers, or schoolmates
Read Also: Everything Need to Know About Knee Tuberculosis