Tuberculose osseuse et articulaire des membres

Abstract

Extraspinal sites account for half of bone and joint tuberculosis cases which are still frequent in areas of endemic tuberculosis, and which are not exceptional in developed countries among immigrants and immunocompromised patients. Bone and joint tuberculosis results from reactivation of resting tubercle bacilli and contains small amounts of bacilli. Two types have been identified: tuberculous arthritis and tuberculous osteomyelitis. All sites can be involved. Main characteristics are a subacute or chronique clinical disease, inconstant constitutional symptoms and inflammatory syndrome, presence of radiological signs, cold abscesses, draining sinus. Tuberculous arthritis leads to progressive joint destruction. MRI is a very effective method for local assessment. In some cases, diagnosis is based on an evidence of associated visceral or lymph node tuberculosis. In most cases, diagnosis is obtained by a local biopsy demonstrating bacteriological and/or histological proof. The prognostic depends on an early diagnosis, on a good therapeutic compliance and on the patient's immunological status. A majority of experts recommends a minimal duration of antituberculous chemotherapy of 9 to 12 months. Surgery, which has become less frequent, may be either an early surgery (abscess drainage, synovectomy or joint debridment, etc.) or a secondary surgery including arthrodesis and joint replacement. Total hip or knee arthroplasty need a quiescent period of sufficient duration and has to be associated with pre- and postoperative chemotherapy.