Tuberculosis (TB) of the hip joint, Hip Tuberculosis, is common in the Western Cape and should be considered in the differential diagnosis of any child with a limp and/or a stiff hip. With Hip Tuberculosis, the hip is found to be stiff, usually held in flexion and adduction. ESR is usually significantly elevated and various skin tests for tuberculosis may be positive.
Unfortunately neither of these investigations is diagnostic and, even if the hip x-ray shows the classic signs of osteopenia as well as chondrolysis (global joint space narrowing) – peri-articular cysts and ankylosis represent late changes, a biopsy may be necessary to differentiate this condition from idiopathic chondrolysis and rarer rheumatological conditions.
Pulmonary tuberculosis may be present concurrently and will increase the index of suspicion, however, many cases of hip tuberculosis present with no evidence of this. Initial treatment is medical with short term skin traction, if required, in order to resolve muscle spasm. If stiffness persists, it is essential to allow the hip to stiffen up in a functional position, this may be achieved with external or internal fixation. Once the TB has been completely treated and the patient presents with refractory hip stiffness or secondary osteoarthritis, a total hip replacement may be considered.
