Tuberculosis of hip in children: A retrospective analysis

Abstract

Background:Tuberculosis (TB) of hip constitutes nearly 15% of all cases of osteoarticular tuberculosis. We report a retrospective study carried out on 43 children with hip TB.Materials and Methods:Forty-three children of TB hip treated between 1971 and 2000 were analysed. Twenty-four children of the early series were treated with streptomycin (S), isoniazid (H) and PAS (Pa) for 18 months (3HPaS, 15 HPa), while 19 children in the later series were treated with isoniazid (H), rifampicin (R) and ethambutol (E) or pyrazinamide (Z) for 12 months [(12 RHE(Z)]. Five out of 18 children with radiologically normal appearing type hip TB were treated with chemotherapy alone and 38 children were subjected to surgery; simple synovectomy alone in 31 hips, joint debridement in six hips, and proximal femoral varisation osteotomy in one. After surgery hips were immobilized in cast for one to three months according to the severity of the disease and patients pain tolerance, and then were mobilized under leg traction in bed gradually till pain subsided completely.Results:TB of hip healed with minimum sequelae in all children. In 18 Type one hip TB, normal hip (synovial form) anatomy was maintained, and in 25 patients with advanced lesions some defect in the femoral head and acetabulum was noticed, though painless good hip motion was maintained. Excellent to good results were obtained in 31 children (73.1%), fair in eight (18.6%), and poor in four (9.3%). In four patients with poor results, there was some residual morphological defect in the hip. None developed ankylosis of hip.Conclusion:We achieved good outcome with minimum sequelae in this series. The management goal should be aimed not only to heal the disease but also to maintain a painless mobile hip and anatomical cephalocotyloid relationship until maturity, and retard the development of secondary osteoarthritis.

Tuberculosis of the hip in children

“…Traveling, mortar pestle and atrophic types had poorer results. In another pediatric series of 43 children by Moon et al ., results were described as excellent to good in 73%, fair in 18% and poor in 9% respectively 7. Poor results were obtained with protrusio acetabuli and mortar pestle types in this series.…”

“…The exact proportion of tubercular hip affection in the pediatric age group is not known but the disease is rare. There is a paucity of literature regarding osteoarticular tuberculosis of hip in children with only few dedicated series available in recent indexed English literature and probably none from the Indian subcontinent 67. Thus, the clinicoradiological course in osteoarticular tuberculosis of hip following modern anti tubercular chemotherapy is scantly studied 67.…”

Tuberculosis of hip

“…Recommends early rehabilitation regimen for ambulation as it boosted the patients’ confidence and activity level. 22 In addition to ATT, nutritional supplementation and traction, the specific treatment depends upon the stage of involvement at the time of diagnosis.…”

Bacille Calmette-Guérin Vaccine-Induced Tuberculous Hip Osteomyelitis in an Infant: Case report

“…2,20 A number of confirmed BCG-induced osteomyelitis cases have been reported from Europe and Asia. 5,14 However, to the best of the authors' knowledge, the current patient is believed to be the first confirmed case of BCG-induced TB hip osteomyelitis from Oman.…”

“…In paediatric cases, treatment strategies are primarily focused towards preserving anatomy, joint mobility and growth plates. 1,2,20,23 First-line anti-TB agents include isoniazid, rifampicin, streptomycin, pyrazinamide and ethambutol. A failure to respond to these medications may warrant the use of second-line agents including capreomycin, kanamycin, ethionamide, cycloserine, and paraaminosalicylic acid.…”