Hip Tuberculosis : Symptoms, Causes, Treatment of Hip Tuberculosis in Delhi

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)
• Epiphysis
• Metaphysis
• 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

Hip tuberculosis progresses through the following clinical stages:

• Stage 1 (Stage of Tubercular synovitis)

  There are some chances of joint effusion in your hips due to swelling & pain. It 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) -

  As the hip tuberculosis progresses, the articular cartilage starts breaking and destroys after some time. In this stage, the flexors' sudden movement results in flexion, adduction, and internal rotation deformity. After diagnosis, it is clearly suggested that the space between the joints is reduced. The reduced space is due to damage to the cartilage which becomes 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

Your doctor may suggest certain diagnostic tests which are made separately for children and adults is made separately to know the type and stage of hip tuberculosis.

In children –
Perthes Disease: It mostly affects children of age 4-8 years. The children may show some common symptoms of a painful limp and limited range of motion. When the children are examined clinically, they may have limited abduction and internal rotation and all the range of motions is painful. The children's MRI shows destruction of both the acetabulum and femoral head.

Low-grade septic arthritis: In this type of hip tuberculosis, 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.

FAQs

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