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Li Z, Luo Y, Lu M, Wang Y, Gong T, Hu X, He X, Zhou Y, Min L, Tu C. 3D-printed Personalized Porous Acetabular Component to Reconstruct Extensive Acetabular Bone Defects in Primary Hip Arthroplasty. Orthop Surg 2024; 16:1642-1647. [PMID: 38837297 PMCID: PMC11216820 DOI: 10.1111/os.14097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/25/2024] [Accepted: 04/28/2024] [Indexed: 06/07/2024] Open
Abstract
OBJECTIVE Management of extensive acetabular bone defects in total hip arthroplasty (THA) remains challenging. This study aims to investigate the feasibility and preliminary outcomes of 3D-printed personalized porous acetabular components for the reconstruction of acetabular defects in primary THA. METHODS This retrospective study involved seven patients who received 3D-printed acetabular components in primary THA between July 2018 and March 2021. Preoperatively, acetabular bone defects were evaluated by referencing the Paprosky classification. There were two "Paprosky type IIIA" defects and five "Paprosky type IIIB" defects. The acetabular components were custom-made for each patient to reconstruct the extensive acetabular defects. The hip function was assessed according to the Harris hip score (HHS). Clinical and radiographic outcomes were assessed. RESULTS The average follow-up period was 40 months, ranging from 26 to 57 months. There were no patients lost to follow-up. The HHS improved from 44 (range: 33-53) before the operation to 88 (range: 79-93) at the final follow-up. Postoperative X-rays showed that the 3D-printed personalized components were properly fitted with the acetabulum. The average center of rotation (COR) discrepancy was 2.3 mm horizontally and 2.1 mm vertically, respectively. Tomosynthesis-Shimadzu metal artifact reduction technology images showed that the implant was in close contact with the host bone. Moreover, no complications were observed during the follow-up period, including loosening, dislocation, or component protrusion. CONCLUSION The implantation of 3D-printed personalized acetabular components showed accurate reconstruction, stable mechanical support, and favorable function at short-term follow-up. This may be a viable alternative method for reconstructing extensive acetabular defects in THA.
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Affiliation(s)
- Zhuangzhuang Li
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yi Luo
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Minxun Lu
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yitian Wang
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Taojun Gong
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Xin Hu
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Xuanhong He
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Yong Zhou
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Li Min
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
| | - Chongqi Tu
- Department of Orthopedics and Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
- Model Worker and Craftsman Talent Innovation Workshop of Sichuan ProvinceChengduChina
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Unnikrishnan R, Chacko A, Jasim M, Chandran N, Gowrishankar S. Multifocal Skeletal Tuberculosis - A Case Report. J Orthop Case Rep 2024; 14:77-82. [PMID: 39035370 PMCID: PMC11258745 DOI: 10.13107/jocr.2024.v14.i07.4582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2024] [Revised: 05/17/2024] [Indexed: 07/23/2024] Open
Abstract
Introduction Tuberculosis (TB) remains a pervasive infectious disease, and extrapulmonary manifestations account for a significant proportion of cases. Skeletal involvement is observed in about 10% of extrapulmonary TB instances. While spinal TB is relatively common, sacroiliac (SI) joint TB is a rare occurrence, particularly in immunocompetent individuals. Case Report This case report discusses an unusual presentation in a 19-year-old immunocompetent lady where the spine, acetabulum, and SI joint were concurrently affected. The patient, initially undergoing alternative medicine, exhibited severe pain, weight loss, and restricted mobility. Radiological evaluations, including X-rays and magnetic resonance imaging, revealed extensive vertebral and pelvic destruction with abscess formation. Surgical debridement and stabilization, alongside antitubercular treatment, led to significant improvement. Conclusion This case emphasizes the challenges in diagnosing multifocal skeletal TB, highlights the importance of early intervention, and underscores the impact of alternative medicine on treatment delays. A multidisciplinary approach involving histopathological and microbiological examinations is crucial for optimal management.
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Affiliation(s)
| | - Ankith Chacko
- Department of Orthopaedics and Spine Surgery, KIMS Health, Trivandrum, India
| | - Muhammad Jasim
- Department of Orthopaedics and Spine Surgery, KIMS Health, Trivandrum, India
| | - Nitheesh Chandran
- Department of Orthopaedics and Spine Surgery, KIMS Health, Trivandrum, India
| | - S Gowrishankar
- Department of Orthopaedics and Spine Surgery, KIMS Health, Trivandrum, India
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Yadav S. Tuberculosis of the Iliac Bone and Acetabulum With Iliopsoas, Obturator Internus, and Obturator Externus Abscesses in an Immunocompetent Indian Female: An Extremely Rare Case. Cureus 2024; 16:e55727. [PMID: 38586629 PMCID: PMC10998663 DOI: 10.7759/cureus.55727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 04/09/2024] Open
Abstract
Skeletal tuberculosis is a rare form of extrapulmonary tuberculosis. Due to non-specific clinical features, these cases are often diagnosed very late, ultimately affecting treatment outcomes. The present case is a very rare case of tuberculosis of the iliac bone and acetabulum with iliopsoas, obturator internus, and obturator externus abscesses in an Indian female. She reported pain in her right hip and a limp. It was a difficult diagnosis, especially due to the rare involvement of bones and muscles in the absence of any lesions in the lungs. Nevertheless, the diagnosis was achieved by a detailed radiometric and laboratory workup. She was initiated on antituberculous treatment per her weight for 12 months.
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Affiliation(s)
- Sankalp Yadav
- Medicine, Shri Madan Lal Khurana Chest Clinic, New Delhi, IND
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Alam M, Okapa RJ, Husain R. Tuberculous Septic Arthritis of the Hip Following the Incision and Drainage of a Groin Abscess: A Case Report. Cureus 2024; 16:e54543. [PMID: 38516484 PMCID: PMC10956638 DOI: 10.7759/cureus.54543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2024] [Indexed: 03/23/2024] Open
Abstract
Tuberculosis of the hip is a relatively rare type of septic arthritis that is seldom seen in the developed world today. While pyogenic septic arthritis may present with clear features that help in early diagnosis and treatment, many of these features are absent or overlap significantly with tuberculous arthritis, making the diagnosis a clinical challenge. Here, we present a case of tuberculous septic arthritis seen in our clinic following the surgical incision and drainage of a groin abscess with minimal hip symptoms. We discuss the therapeutic approach for the patient and briefly review other reported cases of tuberculous septic arthritis in the literature.
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Affiliation(s)
- Mahmood Alam
- Department of Orthopaedics, Salmaniya Medical Complex, Manama, BHR
| | - Robert J Okapa
- Department of Orthopaedics, Salmaniya Medical Complex, Manama, BHR
| | - Rola Husain
- Department of Radiology, Salmaniya Medical Complex, Manama, BHR
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Agyapong Osman K, Amoah E, Annan GK, Bannerman E. Multiple Joint Pain Progressing to Inability to Walk in a 12-year-old Boy. Pediatr Rev 2024; 45:108-110. [PMID: 38296774 DOI: 10.1542/pir.2020-004919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
- Kwabena Agyapong Osman
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
- University of Ghana Medical School, Accra, Ghana
| | - Evelyn Amoah
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
- University of Ghana Medical School, Accra, Ghana
| | - George K Annan
- Department of Child Health, Korle Bu Teaching Hospital, Accra, Ghana
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Kushwaha NS, Kumar D, Gupta RK, Tewari PG, Singh R, Kumar A. Functional outcome of total hip arthroplasty in tubercular hip arthritis: A prospective study. J Clin Orthop Trauma 2024; 48:102337. [PMID: 38304415 PMCID: PMC10828569 DOI: 10.1016/j.jcot.2024.102337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/23/2023] [Accepted: 01/03/2024] [Indexed: 02/03/2024] Open
Abstract
Background Total hip arthroplasty (THA) is a well-established procedure to cure tubercular hip arthritis in patients with healed tuberculosis while its role in active tuberculosis is still debatable. The aim of the study is to investigate the functional outcomes of THA in active tuberculosis with advanced hip arthritis. The reactivation of tuberculosis and complications postoperatively has also been assessed. Materials and methods The current open-ended prospective cohort study was carried out at a tertiary center from 2018 to 2020. Twenty patients of active tubercular hip arthritis (8 females and 12 males) were taken with a follow-up period ranging from 1 year to 3 years, with a mean of 14 months.Biochemical investigations were done both preoperatively and postoperatively. Preoperative anti-tubercular therapy (ATT) regimen was administered, as per standard norms, to patients for a minimum period of 6 weeks, and postoperatively for 6 months-12 months. Postero-lateral and Hardinge approaches were employed in all cases. Clinical and radiological parameters were assessed and functional outcomes were evaluated using the Harris Hip score (HHS). Results The mean age of patients was 37.6 ± 11.38 years. Biochemical parameters were also found to improve postoperatively (p < 0.0001). The mean flexion, extension, abduction, external and internal rotation were found to increase postoperatively (p < 0.001). The mean flexion deformity in the preoperative period was 12.35 ± 4.716, whereas none of the patients had flexion deformities post operatively. The mean shortening was 2.12 ± 0.60 and 1 ± 0 at preoperative and postoperative respectively. The Total hip arthroplasty implant was found stable in all patients. The mean Harris score increased subsequently throughout the follow-up interval and differences were statistically significant (p < 0.0001). None of the patients had reactivation of tuberculosis infection postoperatively. Conclusion Total hip arthroplasty is a reliable option to treat active advanced tubercular hip arthritis and gives good functional outcome with proper preoperative and postoperative ATT regimen.
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Affiliation(s)
- Narendra Singh Kushwaha
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Dharmendra Kumar
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Ravindra Kumar Gupta
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Prakash Gaurav Tewari
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
| | - Riddhi Singh
- Junior Resident, Department of Microbiology, King George's Medical University, Lucknow, UP, India
| | - Ashish Kumar
- Professor, Department of Orthopaedic Surgery, King George's Medical University, Lucknow, UP, India
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Kushwaha NS, Singh A, Saroj AK, Verma A, Ansari KA. Protrusio acetabuli in tubercular hip: Outcome of femoral head as autologous bone graft used during total hip replacement. J Clin Orthop Trauma 2023; 44:102247. [PMID: 37822476 PMCID: PMC10562844 DOI: 10.1016/j.jcot.2023.102247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 09/05/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023] Open
Abstract
Purpose Here we present a study of a tuberculosis hip protrusion with a large acetabular defect treated by total hip replacement using a novel technique without the use of any protrusio ring, wire mesh, or cage. To our knowledge, such a technique has not been described in the literature previously. Methodology 25 patients with a past treatment history of hip tuberculosis came to our medical college with complaints of worsening pain in the hip joint and limping. The hip pain and limping were progressive in nature and became more severe, and his affected lower limb shortened. Results The average AK distance (horizontal distance between Kohlar line and the medial acetabular border) before surgery was 8 mm (range: 1-16). For the acetabular implant, the mean abduction angle was 45° (range: 41-48), and the mean anteversion angle was 18° (range: 13-24). The average preoperative shortening for limb length inequality was 4 mm (range: 0-11). The average HHS (Harris Hip Score) during follow-up was 87.6 points. Conclusion In TB hip protrusio, an autograft of the femur head is used to fill the acetabular defect and provide a good approach for these patients without any extra economic burden or complications as seen in a metallic ring or cage.
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Affiliation(s)
| | - Arpit Singh
- Department of orthopaedics, K.G. Medical University, Lucknow, India
| | - Atul Kumar Saroj
- Department of orthopaedics, Dr SLP Autonomous State Medical College, Pratapgarh, India
| | - Ashutosh Verma
- Department of orthopaedics, K.G. Medical University, Lucknow, India
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Al-Tikrity MA, Mohamed A, K A Yasin A, Elamin NH, Mohamed A. A Subacute Presentation of Isolated Tuberculous Septic Hip Arthritis. Cureus 2023; 15:e43493. [PMID: 37719556 PMCID: PMC10500077 DOI: 10.7759/cureus.43493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/19/2023] Open
Abstract
Tuberculous septic arthritis is a rare type of septic arthritis that is caused by Mycobacterium tuberculosis. However, it can lead to devastating complications if not diagnosed and treated correctly. We hereby report a 41-year-old female with no medical history who presented with a three-week history of right hip pain and inability to bear weight, found to have moderate to severe tenderness at the right anterior hip and gluteal area and limitation of joint movement. Magnetic resonance imaging (MRI) of the hip showed features of right hip septic arthritis with synovitis and anteromedial and posteromedial small collections. She was diagnosed with tuberculosis (TB) after joint fluid aspiration, and she was started on anti-TB treatment including isoniazid, rifampicin, ethambutol, and pyrazinamide directly after. Considering the case and the subacute presentation that can mimic bacterial septic arthritis, clinicians should always consider TB infection in their differential diagnosis upon assessing a suspected patient with septic arthritis even with a subacute presentation to achieve the correct diagnosis and start appropriate treatment to avoid its harmful complications.
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Affiliation(s)
| | | | | | | | - Anas Mohamed
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
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Laya BF, Concepcion NDP, Andronikou S, Abdul Manaf Z, Atienza MIM, Sodhi KS. Imaging recommendations and algorithms for pediatric tuberculosis: part 2-extrathoracic tuberculosis. Pediatr Radiol 2023; 53:1782-1798. [PMID: 37074457 DOI: 10.1007/s00247-023-05650-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 03/16/2023] [Accepted: 03/17/2023] [Indexed: 04/20/2023]
Abstract
Despite advances in diagnosis and treatment in recent years, tuberculosis (TB) remains a global health concern. Children are amongst the most vulnerable groups affected by this disease. Although TB primarily involves the lungs and mediastinal lymph nodes, it can affect virtually any organ system of the body. Along with clinical history combined with physical examination and laboratory tests, various medical imaging tools help establish the diagnosis. Medical imaging tests are also helpful for follow-up during therapy, to assess complications and exclude other underlying pathologies. This article aims to discuss the utility, strengths and limitations of medical imaging tools in the evaluation of suspected extrathoracic TB in the pediatric population. Imaging recommendations for the diagnosis will be presented along with practical and evidence-based imaging algorithms to serve as a guide for both radiologists and clinicians.
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Affiliation(s)
- Bernard F Laya
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112, Philippines
- Department of Radiology, St. Luke's Medical Center College of Medicine William H. Quasha Memorial, Quezon City, Philippines
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Global City, Rizal Drive cor. 32nd St. and 5th Ave., 1634, Taguig, Philippines
| | - Nathan David P Concepcion
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112, Philippines.
- Section of Pediatric Radiology, Institute of Radiology, St. Luke's Medical Center - Global City, Rizal Drive cor. 32nd St. and 5th Ave., 1634, Taguig, Philippines.
| | - Savvas Andronikou
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, and the Children's Hospital of Philadelphia, Philadelphia, USA
| | - Zaleha Abdul Manaf
- Al Islam Specialist Hospital, Kuala Lumpur, Malaysia
- Faculty of Medicine, Bioscience & Nursing, MAHSA University, Kuala Lumpur, Malaysia
| | - Maria Isabel M Atienza
- Institute of Pediatrics and Child Health, St Luke's Medical Center - Quezon City, 279 E. Rodriguez Sr. Ave., Quezon City, 1112, Philippines
- Department of Pediatrics, St. Luke's Medical Center College of Medicine William H. Quasha Memorial, Quezon City, Philippines
| | - Kushaljit Singh Sodhi
- Department of Radiodiagnosis, PGIMER, Chandigarh, India
- Mallinckrodt Institute of Radiology, Washington University in St. Louis School of Medicine, St. Louis, MO, USA
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Raja BS, Ansari S, Yadav R, Regmi A, Kurmi AC, Kalia RB. Total Hip Replacement in Active and Inactive Tuberculosis Hip: A Systematic Review. Indian J Orthop 2023; 57:351-370. [PMID: 36825271 PMCID: PMC9941390 DOI: 10.1007/s43465-023-00817-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/05/2023] [Indexed: 01/13/2023]
Abstract
Introduction Tuberculosis of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip. Total hip arthroplasty (THA) in patients with advanced arthritis offers a painless and mobile joint with good functional outcome but some aspects of THA in TB hip have been controversial in the past due to the concerns of disease reactivation, especially when disease activity is factored in. Various factors like timing of surgery, Antitubercular therapy (ATT) initiation timing, reactivation, complications etc needs to be evaluated very carefully before planning for such cases. Methods Electronic databases like MEDLINE, EMBASE, Cochrane library, Clinicaltrials gov and OpenGrey were searched. The key words used were "Tuberculosis", "Tuberculosis of hip", Hip tuberculosis, "TB", "THR", "total hip replacement", "total hip arthroplasty","THA", "ankylosed hip", "fused hip", "arthrodesis" along with boolean operators "AND" and "OR". Out of a total of 1634 articles, 38 were selected for full text review and 22 articles were finally included in the study. Results For the timing of surgery most authors relied on the inflammatory markers to settle down with ATT before performing THA. 15 authors advocated use of pre-operative ATT with 6 studies recommending at least 2 weeks and 3 studies advocating atleast 3 months of ATT pre surgery.Single stage THA was performed in most studies(214 hips vs 18 hips) as opposed to 2 or 3 stage surgery. In the active disease 72.8% of the hips had uncemented prosthesis, 25.6% hips underwent cemented and 1.5% hips had hybrid THA fixation. Overall reactivation of the infection was seen in 2.47% cases. All authors reported excellent clinical improvement (mean HHS improvement 37.17 to 88.62).
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Affiliation(s)
- Balgovind S. Raja
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Sajid Ansari
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Robin Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Anil Regmi
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Arun Chaudhari Kurmi
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
| | - Roop Bhusan Kalia
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, 249202 India
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Muacevic A, Adler JR. Do Changes in Hemoglobin and C-Reactive Protein Levels in Patients With Hip Tuberculosis After Two Months of Treatment Predict Tubercle Bacilli Deletion? Cureus 2022; 14:e32853. [PMID: 36578841 PMCID: PMC9780708 DOI: 10.7759/cureus.32853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/22/2022] [Indexed: 12/24/2022] Open
Abstract
Background and objective Tuberculosis (TB) of the hip refers to the hip infection caused by tubercle bacilli. Treatment for hip TB includes anti-TB medications, surgery to remove joint abscesses, and orthopedic surgery. It is necessary to conduct tests to confirm that the tubercle bacilli have been eradicated following the treatments. In this study, we aimed to assess the change in hemoglobin and C-reactive protein (CRP) serum levels in patients with hip TB before and two months after receiving specific treatments. We sought to determine whether they are significant tests for the treatment prognosis of hip TB. Methods We employed a prospective cohort design for this study. It was conducted at National Lung Hospital, Hanoi, and involved 24 hip TB patients with intra-articular abscesses who were treated at the center during the period from October 2016 to October 2021. Blood hemoglobin, CRP serum level, and abscesses on hip MRI were assessed before and two months after treatments. Hemoglobin was examined by spectrophotometry, and CRP serum was measured using the immunoturbidimetric method. Results Before treatments, the average hemoglobin level in the patients was 11.48 ± 1.85 g/dl; the average CRP serum level was 63.53 ± 36.47 mg/l. After two months of treatments, the average hemoglobin level increased significantly to 13.22 ± 1.36 g/dl, while the average CRP level reduced significantly to 12.55 ± 11.34 mg/l. However, five cases displayed abnormal findings. These five individuals continued to have intra-articular abscesses. Conclusion In individuals who reacted well to the therapy, blood hemoglobin and CRP serum levels improved. Blood hemoglobin and serum CRP assays can be utilized to monitor outcomes in hip TB therapy.
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Kamal AF, Oktari PR, Kurniawan A, Kodrat E, Mumpuni NA. Clinical Outcomes of Delayed Osteoarticular Tuberculosis: A Review of 30 Cases. Orthop Res Rev 2022; 14:351-363. [PMID: 36299465 PMCID: PMC9590347 DOI: 10.2147/orr.s366294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/26/2022] [Indexed: 11/07/2022] Open
Abstract
Purpose The lack of knowledge regarding osteoarticular tuberculosis (TB) cases in Indonesia leads to delayed and chronic conditions. This study aims to evaluate clinical outcomes of patients with osteoarticular TB. Materials and Methods Thirty osteoarticular cases were retrospectively analyzed, with a focus on non-immunocompromised patients without spine involvement. Chemotherapy length, operative treatment method, and infection recurrence were evaluated. Results The majority (60%) of patients were aged between 19 to 49 years. The most common complaint was painful swelling, particularly during physical activity. Weight-bearing joints, such as the hips, knees, and ankles, were the most affected. Laboratory results showed over half of the patients had anemia, 96% had elevated erythrocyte sedimentation rate (ESR), and 76% had elevated C-reactive protein (CRP) levels. Radiological findings varied, with lytic lesions, abscesses, and joint destruction observed. All patients presented with pathognomonic histological tubercle appearances, with caseous necrosis, lymphocytes, and Langhans giant cells present. Twenty-nine cases were treated with anti-TB drugs for 12 months, while one recurrent case received the drugs for 24 months. All patients underwent surgery to gain local infection control. Conclusion Osteoarticular TB is a common manifestation of extrapulmonary TB and must not be overlooked. Early detection of osteoarticular TB may prevent limb morbidity. Although anti-TB drugs are the primary treatment for osteoarticular TB, in some cases, surgery is required to establish a diagnosis and gain local infection control.
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Affiliation(s)
- Achmad Fauzi Kamal
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Prima Rizky Oktari
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia,Correspondence: Prima Rizky Oktari, Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jl Diponegoro No. 71, Central of Jakarta, Jakarta, Indonesia, Email
| | - Aryadi Kurniawan
- Department of Orthopedic and Traumatology, Faculty of Medicine, Universitas Indonesia, Dr Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Evelina Kodrat
- Department of Anatomical Pathology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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Yang L, Zuo J, Li L, Wang D, Yang X, Tang X. Treatment of Stage I-III Hip Joint Tuberculosis With Open Surgical Debridement and Hip Spica in Children: A Retrospective Study. J Pediatr Orthop 2022; 42:482-487. [PMID: 35941096 PMCID: PMC9470041 DOI: 10.1097/bpo.0000000000002227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aimed to evaluate the outcome of surgical debridement combined with postoperative hip spica immobilization in the treatment of hip joint tuberculosis in children. METHODS This retrospective study enrolled 87 children with stage I to III hip joint tuberculosis treated surgically at our hospital from January 2010 to January 2016. All patients considering hip tuberculosis routinely received a 4-week conservative treatment first, including rest, protected weight-bearing, and 4-drugs antitubercular chemotherapy. Surgical debridement was indicated when there was no relief after this conservative protocol. Patients were divided into 2 groups according to the duration of hip spica immobilization after operation: group A (hip spica for 4 wk, 39 patients) and group B (hip spica for 6 wk, 48 patients). All patients were recommended partial weight-bearing for 7 days and then followed the same hip joint exercises program when spica was removed. Postoperative radiographs, hip dislocation or subluxation, and modified Harris hip score (MHHS) were assessed. All patients were followed up at least 5 years. RESULTS There were 87 patients enrolled in our study, including 34 females and 53 males, with a mean age of 7.2±2.8 years old (range: 2 to 14 y). No significant difference was observed between these 2 groups in baseline data. In group A, the mean MHHS improved from 52.1±14.7 before surgery to 87.8±8.3 at the final follow-up ( P <0.000). In group B, there was also a significant difference between the preoperative MHHS (52.7±9.4) and the final MHHS (88.6±6.5) ( P <0.000). Although there was no significant difference between these 2 groups in the final MHHS ( P =0.593), there were also no significant differences between these 2 groups in wound healing delay (3 in group A and 6 in group B, P =0.705) and pathologic subluxation (3 in group A and 1 in group B, P =0.467). The only difference between group A (79.2±8.5) and group B (75.5±7.5) was the early functional outcome assessed by using MHHS after 1 month of hip joint exercises ( P =0.032). CONCLUSIONS Surgical debridement combined with antitubercular chemotherapy is an effective treatment for stage I to III hip tuberculosis in children when there is no improvement after conservative treatment. Prolonged hip spica immobilization may not reduce the risk of hip subluxation after open surgical debridement but could lead to a delay in early functional recovery. Time of spica immobilization should be individualized and based on the surgeon's evaluation and the patient's condition.
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Affiliation(s)
- Lei Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Jingjing Zuo
- Rehabilitation Medicine Centre, West China Hospital, Sichuan University, Sichuan, People’s Republic of China
| | - Lang Li
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Daoxi Wang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Xiaodong Yang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
| | - Xueyang Tang
- Department of Pediatric Surgery, West China Hospital, Sichuan University
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14
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Koshire S, Jain S, Wankhade A. Proximal femur shaft fracture in a case of ipsilateral resection arthroplasty of a tuberculous hip - A rare case report. J Clin Orthop Trauma 2021; 24:101716. [PMID: 34926148 PMCID: PMC8646163 DOI: 10.1016/j.jcot.2021.101716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 11/16/2021] [Accepted: 11/20/2021] [Indexed: 10/19/2022] Open
Abstract
Femur shaft fracture is a common entity in orthopaedic practice, but how commonly does one encounter a subtrochanteric femur fracture in ipsilateral resection arthroplasty of a tuberculous hip after a decade of uneventful unassisted ambulation post resection procedure ? Till date only 2 patients have been reported worldwide with femur diaphyseal fracture with a history of ipsilateral resection arthroplasty all performed within a year of fracture occurrence. The intriguing factor of our case was the fact that post resection, patient was ambulatory for a decade and the fracture occurred at a subtrochanteric level. Thus we report a case of 35 year old male with subtrochanteric femur fracture due to minor trauma to right thigh, with a history of tuberculous arthritis of right hip for which surgical management in the form of resection arthroplasty was done 10 years back. After a thoughtful decision making and plan formulation we managed the patient with surface fixation with a pre contoured GT (greater trochanter) configuration plate after taking into consideration status of intact GT, osteoporosis, pseudoarthrosis level and post operative ambulation and rehabilitation.
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15
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Zhu RT, Shen LP, Chen LL, Jin G, Jiang HT. One-stage total hip arthroplasty for advanced hip tuberculosis combined with developmental dysplasia of the hip: A case report. World J Clin Cases 2021; 9:8587-8594. [PMID: 34754872 PMCID: PMC8554418 DOI: 10.12998/wjcc.v9.i28.8587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/03/2021] [Accepted: 08/12/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A patient with advanced tuberculosis of the hip joint combined with Crowe type IV developmental dysplasia of the hip (DDH) and a drainage sinus is a rare condition. There are no previous reports of this condition, and it is a complex challenge for surgeons to develop a treatment scheme.
CASE SUMMARY We report a 73-year-old male patient with severe hip pain and drainage sinus of the left hip for one month. Approximately 40 years ago, a drainage sinus occurred at the lateral left hip was healed at the local hospital with anti-infectious therapy. After the sinus healed, gradual pain occurred in the left hip for 40 years. Approximately one month prior, hip pain was sharply aggravated, and a drainage sinus reoccurred in the left hip. The X-ray and computed tomography examinations showed destruction of the head and neck of the left femur, as well as an acetabular deformity. The results of Mycobacterium tuberculosis antibody and Xpert were positive. Therefore, the patient was diagnosed with advanced TH combined with Crowe type IV DDH. After 22 d of treatment with anti-tuberculosis chemotherapy, the sinus healed, and the patient underwent one-stage total hip arthroplasty (THA) surgery consisting of debridement, osteotomy, and joint replacement. After surgery, the patient received anti-tuberculosis chemotherapy drugs for nine months, with no recurrent infection. After one year of follow-up, the Harris score of the patient increased from 21 pre-THA to 86.
CONCLUSION Although drainage sinuses are a contraindication to one-stage THA, one-stage THA is still an effective and safe surgical method after the sinus heals.
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Affiliation(s)
- Rang-Teng Zhu
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- Department of Orthopedics, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
| | - Li-Ping Shen
- Clinical Laboratory, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- Clinical Laboratory, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
| | - Ling-Lin Chen
- Department of Pathology, Taizhou Hospital of Zhejiang Province affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- Department of Pathology, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
| | - Gang Jin
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- Department of Orthopedics, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
| | - Han-Tao Jiang
- Department of Orthopedics, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Taizhou 317000, Zhejiang Province, China
- Department of Orthopedics, Enze Hospital, Taizhou Enze Medical Center (Group), Taizhou 318000, Zhejiang Province, China
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16
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Chen C, Yin Y, Xu H, Chen G. Early clinical outcomes of one-stage total hip arthroplasty for the treatment of advanced hip tuberculosis. J Orthop Surg (Hong Kong) 2021; 29:23094990211000143. [PMID: 33745383 DOI: 10.1177/23094990211000143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the clinical efficacy of one-stage total hip arthroplasty (THA) for treating the advanced hip tuberculosis. METHODS A retrospective study was conducted from July 2013 to June 2018, including 19 patients with advanced hip tuberculosis. All patients underwent total hip arthroplasty through posterior approach, and the surgical efficacy was evaluated. RESULTS Nineteen patients were followed up from 24 months to 48 months, the mean follow-up were 32.1 months. All the incisions healed in grade A. There were no aseptic loosening, dislocation or recurrence of hip tuberculosis after operation. At the last follow-up, the Harris score of the patients was (89.3 ± 6.7), which was significantly higher than (38.2 ± 10.5) of the patients before operation (P < 0.05); the flexion-extension range of motion was (93.6° ± 12.1°), which was significantly larger than (38.2° ± 10.5°) of the patients before operation (P < 0.05). CONCLUSION The one-stage total hip arthroplasty with regular antituberculosis treatment can attain satisfactory clinical efficacy in the treatment of advanced hip tuberculosis, which can relieve the joint pain and improve the joint function, without recurrence of hip tuberculosis.
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Affiliation(s)
- Chang Chen
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Yiran Yin
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Huan Xu
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
| | - Ge Chen
- Department of Orthopaedics, 74647The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.,Sichuan Province Laboratory of Orthopaedic Engineering, Luzhou, Sichuan, China
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17
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Prasetyo M, Adistana IM, Setiawan SI. Tuberculous septic arthritis of the hip with large abscess formation mimicking soft tissue tumors: A case report. Heliyon 2021; 7:e06815. [PMID: 33981885 PMCID: PMC8082261 DOI: 10.1016/j.heliyon.2021.e06815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 02/22/2021] [Accepted: 04/12/2021] [Indexed: 11/30/2022] Open
Abstract
Background Tuberculous septic arthritis is an infection that occurs inside the joint or synovial fluid and joint tissues caused by Mycobacterium tuberculosis. It may show wide variability of clinical symptoms and imaging appearance, ranging from asymptomatic with a normal radiographic examination to severe joint pain along with joint destruction, osteomyelitis, and abscess formation. This article presents radiographic and MR imaging appearance from a case of tuberculous septic arthritis with large abscess formation mimicking soft tissue tumor. Case presentation We reported a 32-year-old female with a slowly enlarging lump on her right proximal thigh within the last 4 months along with slowly progressing joint pain. Both radiographic and MR images showed destruction of the femoral head and acetabular roof, with a formation of large rim-enhanced abscess that extending superficially and distally until mid-thigh. The patient underwent open drainage surgery and excisional biopsy. Histopathological examination showed chronic granulomatous inflammation caused by tuberculous infection. Conclusion MR imaging combined with radiographic and clinical information played a very important role in the diagnosis of tuberculous septic arthritis with abscess, and to differentiate it from soft tissue neoplasms.
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Affiliation(s)
- Marcel Prasetyo
- Department of Radiology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Indah Maria Adistana
- Department of Radiology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
| | - Stefanus Imanuel Setiawan
- Department of Radiology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo National Central General Hospital, Jakarta, Indonesia
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18
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Gautam D, Jain VK, Iyengar KP, Vaishya R, Malhotra R. Total hip arthroplasty in tubercular arthritis of the hip - Surgical challenges and choice of implants. J Clin Orthop Trauma 2021; 17:214-217. [PMID: 33868917 PMCID: PMC8047221 DOI: 10.1016/j.jcot.2021.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/20/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022] Open
Abstract
Osteoarticular tuberculosis of the hip joint can be a debilitating disease that can result in severe cartilage degeneration, destruction, and eventual painful arthritis of the hip. Usually, a secondary affliction to a primary lung disease, Tuberculosis (TB) of the hip can be difficult to diagnose due to its indolent natural history and deep-seated nature of the hip joint itself. Untreated, ultimately TB hip leads to disabling arthritis of the hip with limitation of activities of daily living, livelihood, and socio-economic consequences. Historic surgical options such as arthrodesis and excision arthroplasty of TB hip have limitations and several disadvantages. Total hip arthroplasty (THA) is a viable option to restore mobility and relieve pain in patients with severe post-tuberculous arthritis but has been controversial in the past due to the concerns of disease reactivation. We evaluate the current role of THA in TB of the hip, its various applications in different presenting scenarios with a guide to surgical tips and tricks for managing this challenging condition.
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Affiliation(s)
- Deepak Gautam
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Vijay K. Jain
- Department of Orthopaedics, Atal Bihari Vajpayee Institute of Medical Sciences, Dr Ram Manohar Lohia Hospital, New Delhi, 110001, India,Corresponding author.
| | | | - Raju Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, Sarita Vihar, Mathura Road, 110076, New Delhi, India
| | - Rajesh Malhotra
- Department of Orthopaedics, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
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19
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Nawatthakul A, Yuenyongviwat V. Tubercular arthritis presenting as osteonecrosis of the femoral head: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20971408. [PMID: 33224501 PMCID: PMC7656864 DOI: 10.1177/2050313x20971408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 10/15/2020] [Indexed: 11/23/2022] Open
Abstract
A tuberculosis hip that presents as osteonecrosis of the femoral head is an extremely rare condition. There are no previous reports of this condition, and there is no consensus on the method of total hip arthroplasty for this group of patients. We present a case of a 72-year-old man who had clinical gradual hip pain in both hips for 1 year. He was diagnosed with post-collapsed osteonecrosis of the femoral head in both hips and was scheduled for total hip arthroplasty of the left hip. During his clinical follow-up, he suddenly experienced excruciating acute pain. Investigation to rule out infection was positive for only C-reactive proteins, but his synovial fluid work-up was negative. An intraoperative finding revealed that there was collapse of the femoral head with eroded acetabular cartilage and rice body–like synovitis. Total hip arthroplasty was performed, and the tissue was sent for diagnosis. Tissue acid-fast bacilli were positive, so the patient received anti-tuberculosis drugs for 9 months, with no recurrent infection. Tuberculosis arthritis presenting as osteonecrosis of the femoral head is a complex condition that is difficult to diagnose due to the radiographic pictures of femoral head collapse and arthritic change being similar in both diseases. Acute pain onset with rapid collapse of the femoral head should be a consideration or suspect for this infectious condition. Hence, investigation to rule out infection is important. Anti-tuberculosis drugs are the standard treatment for early or advanced arthritis, and one-stage or two-stage total hip arthroplasty is the choice of treatment for advanced arthritis.
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Affiliation(s)
| | - Varah Yuenyongviwat
- Varah Yuenyongviwat, Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, Hat Yai 90110, Songkhla, Thailand.
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20
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Dangvard Pedersen D, Milner GR, Kolmos HJ, Boldsen JL. The association between skeletal lesions and tuberculosis diagnosis using a probabilistic approach. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2019; 27:88-100. [PMID: 30661884 DOI: 10.1016/j.ijpp.2019.01.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 12/10/2018] [Accepted: 01/05/2019] [Indexed: 06/09/2023]
Abstract
Sensitivity and specificity estimates for 18 skeletal lesions were generated from modern skeletons for future paleoepidemiological analyses of tuberculosis prevalence in archaeological samples. A case-control study was conducted using 480 skeletons from 20th century American skeletal collections. One-half of the skeletons were documented tuberculosis cases (Terry Collection). The remaining age and sex-matched skeletons were controls (Bass Collection). The association between 18 candidate skeletal lesions and tuberculosis was established by comparing lesion distributions in case and control groups. Lesion indicators at six locations - visceral surface of ribs, ventral vertebral bodies, lateral part of ilium, acetabular fossa, iliac auricular surface, and ulna olecranon process - occurred significantly more often among cases than in controls, and were associated with one another. The most useful indicator proved to be a bony reaction on ventral thoracic and lumbar vertebral bodies. Its presence means a 53.3% probability of a true tuberculosis diagnosis. Because of the nature of the reference sample - 20th century American cases - sensitivity and specificity estimates will better estimate disease prevalence in archaeological samples from cultural settings where pulmonary tuberculosis predominated. The general approach of this proof-of-concept study is applicable to other diseases that occur commonly and affect bone.
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Affiliation(s)
- Dorthe Dangvard Pedersen
- Unit of Anthropology (ADBOU), Department of Forensic Medicine, University of Southern Denmark, Denmark.
| | - George R Milner
- Department of Anthropology, Pennsylvania State University, USA
| | - Hans Jørn Kolmos
- Department of Clinical Microbiology, Odense University Hospital, Denmark
| | - Jesper Lier Boldsen
- Unit of Anthropology (ADBOU), Department of Forensic Medicine, University of Southern Denmark, Denmark
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21
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Holmen JE, Yi J. Pyogenic Arthritis. Pediatr Ann 2019; 48:e354-e359. [PMID: 31505009 DOI: 10.3928/19382359-20190816-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The incidence of septic arthritis among children in developed countries is estimated to be 4 to 10 cases per 100,000 children per year, peaking at about age 3 years. The most common causative organism is Staphylococcus aureus, although the microbiology varies by age. Prompt diagnosis and treatment is critical to prevent long-term sequelae. Empiric therapy should target the most likely causative organism(s) and total duration generally falls between 10 days and 4 weeks depending on clinical course, patient age, and organism. A short intravenous course is sufficient in most cases. Unusual and alternate causes of arthritis should be considered in special cases. [Pediatr Ann. 2019;48(9):e354-e359.].
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22
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Erraoui M, Rkain H, Aachari I, Tahiri L, Allali F. Coxitis with synovial hypertrophy. J Med Ultrasound 2019; 27:213-214. [PMID: 31867199 PMCID: PMC6905258 DOI: 10.4103/jmu.jmu_4_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 10/06/2017] [Accepted: 11/17/2017] [Indexed: 11/04/2022] Open
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23
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Zou D, Zhou J, Jiang X. Diagnosis and management of spinal tuberculosis combined with brucellosis: A case report and literature review. Exp Ther Med 2018; 15:3455-3458. [PMID: 29545868 DOI: 10.3892/etm.2018.5812] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Accepted: 02/01/2017] [Indexed: 11/06/2022] Open
Abstract
Tuberculosis combined with brucellosis is a very rare condition. Overlapping clinical presentation and laboratory parameters of tuberculosis and brucellosis may lead to misdiagnosis or delayed diagnosis of the condition. The current study presents the case of a 45-year-old male with symptoms of lower back pain, non-tender swelling in the right flank, intermittent hyperpyrexia, sweating, body aches and numbness and weakness of right lower limb. A lumbar computed tomograph (CT) scan and magnetic resonance imaging indicated vertebral destruction and the formation of sequestra and thecal sac compression. Tuberculosis was suspected, but subsequent culture of blood and pus revealed the co-infection of Mycobacterium tuberculosis and Brucella melitensis. The patient was treated with antibiotics, CT-guided percutaneous drainage of the abscess and posterior approach decompression, debridement, instrumentation and fusion. Co-existence of spinal tuberculosis and brucellosis is rare and clinicians should strengthen the awareness of such conditions in similar patients. CT-guided percutaneous drainage is effective in the diagnosis and management of spinal tuberculosis with abscess.
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Affiliation(s)
- Dexin Zou
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China.,Department of Orthopaedics, Yantai Yantaishan Hospital, Yantai, Shandong 264000, P.R. China
| | - Junlin Zhou
- Department of Orthopaedics, Beijing Chaoyang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Xiaobing Jiang
- Department of Equipment, Yantai Yuhuangdi Hospital, Yantai, Shandong 264000, P.R. China
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24
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Al-Azri MS, Manarang J, Al-Mufargi Y. Bacille Calmette-Guérin Vaccine-Induced Tuberculous Hip Osteomyelitis in an Infant: Case report. Sultan Qaboos Univ Med J 2017; 17:e358-e362. [PMID: 29062564 DOI: 10.18295/squmj.2017.17.03.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/26/2017] [Accepted: 06/08/2017] [Indexed: 11/16/2022] Open
Abstract
To this day, tuberculosis (TB) continues to pose a significant global health burden. The World Health Organization's Expanded Programme on Immunization (EPI) recommends the bacille Calmette-Guérin (BCG) vaccine for infants to protect against the haematogenous spread of primary TB and other more severe types of TB infection. We report an eight-month-old boy who presented to the Armed Forces Hospital, Muscat, Oman, in 2015 with a one-month history of intermittent fever associated with a limited range of motion in the right hip area. He was up-to-date with his EPI vaccinations and had no history of exposure to individuals with TB infections. He was initially treated for bacterial septic arthritis; however, a GeneXpert TB assay revealed the presence of Mycobacterium tuberculosis, BCG strain. To the best of the authors' knowledge, this is the first documented case from Oman of a child with TB hip osteomyelitis due to a BCG vaccination.
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Affiliation(s)
- Mohammed S Al-Azri
- College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Jazel Manarang
- Department of Child Health, Royal Hospital, Muscat, Oman
| | - Yaqoub Al-Mufargi
- Department of Orthopedic Surgery, Armed Forces Hospital, Muscat, Oman
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25
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Mandal N, Anand PK, Gautam S, Das S, Hussain T. Diagnosis and treatment of paediatric tuberculosis: An insight review. Crit Rev Microbiol 2017; 43:466-480. [PMID: 28502224 DOI: 10.1080/1040841x.2016.1262813] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Tuberculosis (TB) is a major public health problem, invading all age groups world-wide. It is an opportunistic infection affecting the individuals alone or with co-infections. Childhood TB is a neglected aspect and a significant health problem in epidemic areas. It constitutes more than 20% of TB incidence. Pediatric TB exists in the shadow of adult TB. The clinicians concentrate on pulmonary manifestation of TB, whereas it is a major problem in both pulmonary and extra-pulmonary infections. The rate of infection with this disease is mostly associated with poverty, social disruption and human immunodeficiency virus (HIV) infection. The diagnosis of extra-pulmonary TB (EPTB) is more difficult than pulmonary TB (PTB). Delayed diagnosis and executive treatment contribute to increase in the mortality rate in endemic areas. This article provides the evidence-based simple and safe screening method, indicating rapid, highly sensitive and specific diagnostic tests for pulmonary and EPTB in children. The most important aspect of treatment is the correct course of anti-tubercular drugs. This review serves the purpose of quick reference for microbiologists, epidemiologists, academicians, students and researchers. It provides guidance regarding early diagnosis and treatment accuracy of pediatric TB.
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Affiliation(s)
| | | | - Subhash Gautam
- b National Institute of Medical Statistics , New Delhi , India
| | - Shritam Das
- c Division of NCDs, Regional Medical Research Centre , Bhubaneswar , India
| | - Tahziba Hussain
- d Regional Medical Research Centre (ICMR) , Bhubaneswar , India
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