Tuberculous Coxitis Research Articles

Etiological Diagnosis of Infectious Coxitis Depending on the Patient's HIV Status

The objective: to develop the procedure for etiological diagnosis of infectious coxitis (IC) depending on the patient's HIV status.Subjects and Methods. The data of medical records of 97 patients with signs of IC were analyzed. Patients were divided into group depending on their HIV status.Results. The time required to diagnose IC was identified, and it made 7.35 ± 1.30 months for HIV-positive patients, and 6.25 ± 0.90 months for HIV negative patients (p > 0.05). The procedure was developed to be implemented when a patient complained of pain in the hip joint. Patients with HIV infection and suspected IC should undergo computed tomography (CT) of the hip joints, and HIV-negative patients should have CT done if the hip joint X-ray is not informative. The use of CT in the HIV+ Group reduced the diagnostic time from 9.4 ± 1.3 to 5.3 ± 1.3 months (p = 0.680), in the HIV- Group – from 8.7 ± 1.2 to 3.8 ± 0.6 months (p = 0.02). The reason why diagnosis took that long was the rare use of invasive methods at the outpatient stage. Thus, puncture of the hip joint was performed in the HIV+ Group in 2.7% of cases, in the HIV- Group – in 10%. Trepanobiopsy performed in a hospital made it possible to establish the etiology of IC in all patients. The diagnostic efficacy of microbiological tests in case of tuberculous coxitis made 48.64% in the HIV+ Group and 30.0% in the HIV- Group, in case of nonspecific coxitis it was 32.43% and 30.0%, respectively.

Reconstructive resection for tuberculous coxitis

Among patients with tuberculous coxitis, the most severe contingent are those in whom, as a result of the transferred process, significant destruction of the joint elements occurred. Before the advent of antibacterial drugs, these patients did not receive sufficient help. Antibacterial drugs made it possible to start surgical treatment. The operation consisted in a radical removal of tuberculous foci and the creation of a supportable limb.

Long-term results of treatment of tuberculous coxitis by means of an outpatient plaster cast

Long-term results of treatment of tuberculous coxitis by means of an outpatient plaster cast were traced for 3-10 years in 130 patients of the Munich orthopedist, clinic A. Keck'om (Zeitschr f. Orthop. Chir, Bd. 43, H. 1, 1922).

Efficacy of antibiotic-impregnated cement spacers in the staged surgical treatment of patients with tuberculous coxitis

Введение. По данным литературы не снижается интерес исследователей к проблеме использования цементных спейсеров с антибиотиками в процессе хирургического лечения туберкулеза крупных суставов. Цель исследования: повысить эффективность хирургического лечения туберкулезного коксита путем применения артикулирующих цементных спейсеров, насыщенных антибактериальными препаратами. Материалы и методы. Изучены результаты хирургического лечения 66 больных туберкулезом тазобедренного сустава 3 стадии, из них 45 пациентам (1-я группа) во время этапной санирующей операции на суставе устанавливали спейсер с использованием полиметилметакрилата с ванкомицином и/или гентамицином. 21 пациенту (2-я группа) выполняли только санирующую операцию. Изучали интенсивность боли в суставе, длительность оперативного вмешательства, среднюю интра- и периоперационную кровопотерю, частоту обострений воспалительного процесса, изменение пространственных взаимоотношений бедренной и тазовой костей, функцию тазобедренного сустава по шкале Harris Hip Score через 1 и в среднем через 7,9 мес после операции. Результаты исследования. До операции интенсивность боли у больных обеих групп не различалась. Установка спейсера у пациентов 1-й группы увеличивала длительность операции в среднем на 19 мин и способствовала достоверному снижению болей. Обострения воспалительного процесса в области операции в 1-й группе наблюдались у одного больного, во 2-й группе — у 4 пациентов (p<0,05). Через 7,9 мес после операции доля больных с нарушениями по G. Hartofilakidis как типы II и III в 1-й группе составила 8,9%, во 2-й группе она оставалась высокой — 42,9% (p<0,05). Прирост показателя функциональной оценки по шкале W. Harris у пациентов 1-й группы был в 3,0 раза большим по отношению к аналогичному во 2-й группе больных. Заключение. Применение спейсеров с антибиотиками в хирургическом лечении туберкулезного коксита позволяет уменьшить интенсивность болевого синдрома и частоту обострений воспалительного процесса, устранить имеющиеся пространственные нарушения костей сустава и увеличить его функциональную состоятельность, тем самым облегчить выполнение последующей операции его тотального эндопротезирования.

Tuberculous coxitis with trochanteric bursitis manifesting a year after immigration to Germany: a case report

BackgroundOsteoarticular tuberculosis is rare in Germany. In particular, trochanteric bursitis is an extremely rare manifestation of osteoarticular tuberculosis. We describe a case of tuberculous coxitis with trochanteric bursitis, successfully treated with a fourfold tuberculostatic therapy.Case presentationWe report the case of a 43-year-old human immunodeficiency virus-negative Sudanese man with osteoarticular tuberculosis, who was originally admitted with the suspected diagnosis of ankylosing spondylitis. Low grade fever together with the positive result of an interferon-gamma release assay test as well as findings from magnetic resonance imaging provided clues to the diagnosis. A definitive diagnosis could be set after a computed tomography-guided biopsy.ConclusionsApart from a rare involvement pattern of osteoarticular tuberculosis, including trochanteric bursitis, this case highlights the increasing importance of osteoarticular tuberculosis as a differential diagnosis of rheumatic disorders. With the growing migration flows from tuberculosis-endemic African countries, clinicians in central and northern Europe may be more frequently confronted with atypical involvement patterns of osteoarticular tuberculosis.

Tuberculous Coxitis: Diagnostic Problems and Varieties of Treatment: A Case Report§

Although the prevalence of tuberculosis reduces, it still belongs to the most important infectious diseases worldwide even in industrial countries.We report an unusual case of tuberculous coxitis in a 28-year-old healthy native female with recurrent hip pain. While X-ray and microbiological examination of the aspirate showed no abnormality, only extended diagnostic measurements and detailed history led to the diagnosis of TBC. Although the patient did not show any pulmonary symptoms open tuberculosis was confirmed. After a course of antibiotic treatment she underwent reconstructive surgery which consecutively improved range of motion. This case report emphasizes that tuberculosis should still be considered as a significant disease even in healthy patients with uncertain complaints in joints without significant initial radiographic abnormalities. We recommend the described diagnostic procedures as well as an antibiotic and surgical treatment.

Cementless total hip arthroplasty for the management of advanced tuberculous coxitis

The question of whether a total joint arthroplasty should be attempted in a patient with a current or previous infection of tuberculosis continues to arouse controversy. The aim of this report was to evaluate the clinical outcomes of cementless total hip arthroplasty for the treatment of advanced tuberculosis of hip. A total of 14 patients with advanced tuberculosis of hip treated by cementless total hip arthroplasty were retrospectively analyzed. For the patients with a definite diagnosis of tuberculosis and elevated levels of CRP (C-reactive protein) and ESR (erythrocyte sedimentation rate) before surgery, preoperative antituberculous medications were prescribed for at least 2 weeks. The inflamed soft tissues and destroyed bones were completely curetted out at the time of operation. Twelve of 14 patients received one-stage cementless total hip arthroplasty after a thorough debridement. For the remaining 2 patients, two-stage strategy was taken with cement articulating spacer implanted after a thorough debridement and followed by cementless total hip arthroplasty at 6-8 months later. All patients were prescribed antituberculous medications postoperatively for the first 6 months. The mean Harris Hip Score (HHS) was 36 preoperatively and 87 at the last follow-up. Within an average follow-up period of 49 months (range: 27 - 77), only one patient had reactivation of tuberculosis 7 months after primary THA (total hip arthroplasty) and received resection arthroplasty. Another 13 patients had no reactivation of tuberculosis and revealed stability by bone ingrowth on both socket and femoral stem. Cementless total hip arthroplasty is a safe and effective procedure for advanced tuberculosis of hip. With a thorough debridement followed by a complete course of antituberculous chemotherapy, active tuberculous infection should not be considered a contraindication for THA. In patients whose diagnosis of tuberculosis is confirmed intraoperatively and with no preoperative antituberculous chemotherapy, or in those a thorough debridement can not be achieved, a two-stage surgery may be considered.

Total Hip Arthroplasty in a fused hip

Purpose : The purpose of this study was to evaluate the clinical and radiographic results of total hip arthroplasty in a fused hip. Material and Method : Out of the 32 cases that nderwent total hip arthroplasty in a fused hip, we reviewed the clinical and radiographic results of 24 hips of 24 patients for a minimum follow-up of two years. Preopreative diagnosis was equale of tuberculous coxitis in 14 cases, sequale of pyogenic coxitis in 8 cases, and sequale of fracture-dislocation of the hip in 2 cases. All hips fused with shortening of the affected limb and flexion contracture. Result : The average Harris hip score improved from 56.2 preoperatively to 93.5 postoperatively. The average lower limb discrepancy improved from 4.2 cm preoperatively to 0.4 cm postoperatively. Radiographically, no radiolucent line was observed between the bone and stem, and vertical subsidence of the stem was not noted. Vertical and horizontal migration of acetabular component by more than 3 mm, and rotational migration above 8 degrees were not noted. Postoperative complications were an intraoperative femoral shaft fracture in 1 case, femoral nerve palsy in 1 case, peroneal nerve palsy in 1 case, and the reactivation of tuberculosis in 1 case. Conclusion : Total hip arthroplasty in a fused hip gave the patients a subjective satisfaction by obtaining joint motion and correcting the fixed deformity. We believe total hip arthroplasty in such patients is a useful treatment, however, long term follow-up is mandatory.

Richard von Volkmann und die Chirurgie an der Friedrichs-Universität in Halle von 1867 bis 1889

Richard von Volkmann (1830-1889) was appointed senior consultant of the University Surgical Hospital in Halle at the young age of 36. On returning home from the war of 1870/1871, he saw traumatic fever rampant in his hospital. He became a rigorous advocate of Lister's method of antisepsis. There were a large number of very serious accidents in the up-coming industrial town of Halle. Acute and chronic inflammation of the joint led to severe disfigurements. By invention of large reconstructive operations von Volkmann was able to obtain impressive results. He was the founder of traumatology and orthopaedic surgery. Tuberculosis was regarded at that time as the most common cause of death. By means of surgery certain forms of the illness could be cured. Tuberculous coxitis and gonarthritis were the most common indications for orthopaedic surgery. Von Volkmann used his distraction method for tuberculous spondylitis.Many terms used in medical practice derive from Richard von Volkmann. He described Volkmann's triangle, ischaemic muscle contractures and resorption fever. He developed a whole range of new methods of surgical procedures and the concept of wound drainage. His name is associated with Volkmann's splint, Volkmann's "sharp spoon" and several other inventions. Richard von Volkmann was one of the founders of the Deutsche Gesellschaft für Chirurgie (German Surgical Society). His famous Träumereien an französischen Kaminen ("Reveries at French Firesides"), an anthology of fairy-tales for his children, played an important role in his life's work.

Reactivation of tuberculosis after total hip replacement

Reactivation of tuberculosis after total hip replacement

Surgical treatment of tuberculous coxitis

We analyzed the long-term outcomes of surgical treatment of 52 patients with tuberculous coxitis treated in the departments of traumatology and orthopedics of the city and republican hospitals of Saransk in 1956-1967. There were 16 men and 36 women. There were 30 patients under the age of 40 and 22 older, 2 patients with a disease duration from 1 to 3 years, 2 from 3 to 5 years, 19 from 5 to 10 years and 29 more than 10 years. 2 patients had longterm non-healing fistulas and 1 had a leaky abscess.

Arthroplasty using of bioplast in tuberculous coxitis.

Arthroplasty using of bioplast in tuberculous coxitis.

A summary of 100 treated cases of tuberculous coxitis

A summary of 100 treated cases of tuberculous coxitis

Arthrodesis in the Treatment of Tuberculous Coxitis Sequelae

Arthrodesis in the Treatment of Tuberculous Coxitis Sequelae

Gaucher's Disease

Gaucher's disease is a somewhat rare familial disturbance of the cellular metabolism in the reticulo-endothelial cells and histiocytes, characterized by an accumulation and retention of the cerebroside kerasin. Thannhauser and his associates (1) explain this deviation from the normal lipid metabolism as an imbalance of intracellular enzymes concerned with the disintegration and synthesis of sphingomyelin and kerasin within the cell and a resulting accumulation of kerasin. The clinical manifestations may be enlargement of the spleen, liver, and sometimes the lymph nodes, pigmentation of the skin, pinguecula-like lesions of the conjunctivae, thrombocytopenia, and frequently a leukopenia. There may be pain in some portion of the osseous system caused by destructive infiltration of the cerebrosidic reticulosis of the bone marrow, and osseous involvement may be the earliest and continue to be the predominating manifestation of the disease. An accompanying fever and leukopenia are usually present. It is of the predominantly osseous type with which this case report deals. Risel (2) was the first to note macroscopic bone changes in Gaucher's disease and described the spongiosa at the upper and lower ends of the femur dotted with rather small, thick, whitish areas, arranged in a stellate form either in nodes or streaks or in a net-like manner. These areas represented deposits of Gaucher cells. The first complete x-ray studies were made by Klercker (3) and Junghagen (4) in 1926. The earliest as well as the most consistent type of change usually occurs as a widening of the lower ends of the femur, just above the condyles (Fischer's sign). This is followed by areas of rarefaction with intermingled areas of sclerosis and a resulting club-shaped conformation. The severe pain over this region when the changes begin to take place, accompanied by fever, makes it easy to confuse this condition with acute osteomyelitis. A history of some preceding trauma can almost always be obtained and, despite the low-grade fever and lack of leukocytosis, operation may be performed. The finding of a sterile pus from which no organism can be grown, coupled with the other findings atypical of acute osteomyelitis, may help to throw doubt on this diagnosis. Once operation has been done, drainage may continue for months. Bony changes occur frequently in the humerus, tibia, fibula, radius, ulna, and ribs. Changes have also been described in the pelvis and skull. Of those cases described in the literature, the most common changes in the long bones include general osteoporosis, large areas of destruction of the spongiosa, and as a late manifestation punched-out areas in the bone with irregular thickening of the cortex. Pathological fractures have been noted in long bones with a destructive lesion. Similar destructive changes in the head of the femur may result in a deformity which must be differentiated from Legg-Perthes' disease, tuberculous coxitis, and chronic osteomyelitis.

125 subtrochanteric osteotomies of the femur

The presented material is homogeneous in its etiological factor and concerns ankylosis of the hip joint after tuberculous coxitis, underwent conservative methods of treatment or not treated at all.

About the technique I will introduce a fixed arthrodesis of the hip using a nail from a prohunter

Analyzing the methods of surgery, fixing the hip joint for tuberculous coxitis, the author proposes the trochanter-valve method, first proposed by Carris and improved by him.