Treatment of tuberculosis of the hip
Between September 1986 and December 1993, 57 patients were seen with tuberculosis of the hip at Kenyatta National Hospital. The diagnosis was proven by histological examination in all and in 54 patients (95%) caseation was present. The sex ratio M: F was 2:1 and ages ranged from 6 to 54 years (mean 30 years) with 26 patients between 21 and 40 years old. The common presentation was a swollen hip, a limp, decreased range of hip movements, fixed flexion deformity and pain. Three patients had protrusion acetabuli and three had subluxed or dislocated hips. Twenty- three patients were anaemic and erythrocyte sedimentation rate (ESR) was raised in all (mean 65mm/hr; range 25-115mm/hr). The mantoux test was positive in 46 (81%), while 17 of the patients (30%) were HIV-positive. Chest radiographs showed active or healed pulmonary tuberculosis in 26 (46%) of the patients. The hip radiographs showed osteopenia with early cyst formation in 43 (75%) and in 14 (25%) patients they demonstrated joint space narrowing and destruction. Treatment was antituberculous chemotherapy (thiacetazone and INAH for 18 months with streptomycin for the first 2 months), diagnostic arthrotomy and traction in abduction. Children with subluxed or dislocated hips were treated in hip spicas. Adductor tenotomy was performed in 17 patients, while five had arthrodesis, three had excisional arthroplasties and two had total hip replacements after chemotherapy. The 43 patients who presented with preserved joint spaces did well but the 14 who presented with reduced joint space, subchondral erosions and protrusion acetabuli or outright dislocation of the hip did poorly.