Early roentgen diagnosis of tuberculosis of the hip in children.

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The early roentgen diagnosis of tuberculosis of the hip in children has received little attention in recent radiologic literature. This is primarily due to the decline of tuberculosis in this country and the advent of the antituberculous chemo-therapeutic agents. However, the disease is far from eradicated; new cases are still being seen, often after irreversible changes have occurred. The usual end-result of tuberculous disease of a joint has been ankylosis (1). There is a reasonable chance, however, since the discovery of antibiotics, of obtaining a mobile joint if the disease is recognized in its early stage. It is important, therefore, to be constantly reminded of the methods of making an accurate diagnosis of this disease in children, to familiarize oneself with the early diagnostic signs and symptoms, and to be aware of the differential diagnosis in their presence. In 1924, Phemister (26) recorded the principal distinguishing features of tuberculous arthritis. Since it appears that these criteria are not widely known, restatement and further illustrations seem indicated. During the past fifteen years, there have been seen at the Alfred I. duPont Institute 9 patients with early roentgen changes in the hips in whom there was microscopic proof of tuberculosis. Not included in this series are 3 cases which clinically and roentgenographically were thought to be tuberculosis but in which either biopsy was not performed or the biopsy report and/or culture were negative. Also excluded are patients with well advanced and of ten healed tuberculosis of the hip, admitted for reconstructive surgery. This paper will be limited to a discussion of early tuberculosis ofthe hip in children. Earlier literature, particularly in the nineteen twenties and nineteen thirties, is filled with reports of excellent results of treatment of tuberculosis of the hip. Rollier (3), for instance, in 1930 reported 74 per cent cures, with function of the hip joint. Not' all the cases, however, were verified by tissue biopsy or bacteriologie examination. In 1921, Sundt (4) stated that in a series of 243 cases of hip disease seen from 1903 to 1918, 29.6 per cent were nontuberculous. Among these were cases of congenital coxa vara, epiphysiolysis, fracture, arthritis deformans, osteomyelitis, syphilis, synovitis of tuberculous origin, hysteria, and Legg-Perthes disease. Neil-son (5) in 1923 gave a differential diagnosis of hip conditions which had been considered tuberculous. In 1930 O'Connor (6), reviewing 189 cases admitted with a tentative diagnosis of tuberculosis, found 54 that were not tuberculous. The following year Milgram (7) reported that, of 88 cases of Legg-Perthes disease, 31 had been diagnosed as tuberculosis on the first admission. In addition, proved tuberculosis was initially misdiagnosed in 38.7 per cent of 142 patients.