Tuberculosis of the iliosacral joints. Treatment, results, prognosis and differential diagnosis

Abstract

In comparison with other specific processes of the pelvic girdle tuberculous foci in the sacro-iliac joints are observed relatively frequently. In the last 26 years (1955 to 1980) 43 patients (28 female, 15 male; 39 Germans, 4 immigrant workers) with 45 sacroiliac tuberculosis were treated in the authors' clinic (44 by surgery). The youngest patient was aged 8, the oldest 67 (average age 33.9 years). Until the diagnosis was clarified the majority of the patients (39 = 92%) had been treated for sciatica and lumbago. In 24 (56%) of the patients the right sacro-iliac joint was affected, in 17 (39%) the left and in 2 (5%) both. Although all the cases showed advanced disease (with extensive destruction), and abscesses, fistulae or other tuberculous foci were found in the majority of the patients, the 1-hour blood sedimentation rates were normal or only slightly elevated in over 50% of them. In 35 cases (78%) the joint was completely destroyed. The post-operative complications (2 patients with 1 fistula each, 1 patient with a wound-healing impairment) did not have an adverse effect on the result of surgery. In the 37 patients (86%) who were examined on average 4.5 years after discharge from the hospital, no recurrences were found. Seventy-four percent of the sacro-iliac joints were partially or completely ankylosed; advanced postarthritic arthrosis was found in the remainder. Only one of the patients followed up, a mason, had to be retrained; the others had resumed their previous occupations on average 1.4 years after being discharged.