TUBERCULOSIS OF

THE JOINT
RIZKI RAHMADIAN
ORTHOPAEDIC SURGEON

Epidemiology and
Prevalence

Tuberulosis bacilli have lived in simbiosis with

minkind since time immemorial

India : Rig Veda and Atharva veda (3500-1800

BC), samhita of Charaka and Sushruta (100
and 600 BC mention this disesase
Yakshma

Grego-Roman civilization phthisis or

consumption

TB lession hace been recorded in Egyptian

mummies

Epidemiology and
Prevalence

The world : 30 million people suffering from

TB

WHO : TB kill 3 million people a year

1-3% TB skeletal system

Epidemiology and
Prevalence

Most common inareas with crowding

An increase of TB infection HIV

Most cases during first 3 decades

Pathology and
Pathogenesis

Primary focus is viscera : lungs, kidney, lymph nodes

Musculoskeletas involes : via hematogenous

Bones and joint TB develop generally 2-3 yaers after

primary focus

Once deposite ingested by mononuclear cells

tubercle is form when lymphosites form a ring around
a group of epitheloid cells caseation then develops
within the center of tubercle cold abscess is formed

Pathology and
Pathogenesis

Tubercular bacille rach the joint space via

blood stream trough sub synovil vessels

Or indirectly from the lession in spishyseal

bone

Articular distruction begins peripherally

does not form proteolytic enzyme with in joint
space preserver for along time

Pathology and
Pathogenesis

Cartilaginous tissue is resistant to TB

destruction

Metaphyseal tuberculous lession infect the

neighboring joint through the sub periosteal
space and through the capsule, or through the
destruction of epiphyseal plate

Once tubecular process reach the subchondral

region the articular cartilage loses its
notrition

Pathology and
Pathogenesis

When infection start as tuberulous synovitys

the course is usually slow

The synovial membrane become swollen and

congested, and synovial effusion

Tuli Classification

Tuberculosis of the
Hip Joint

15 percent of all
osteoarticular TB

Iitial lession
acetetabular roof,
metaphyseal region
(babcocks triagles,
or in greater
trochanter)

Rarely start in the

synovial

Clinical Finding

Constitutional symtomp : low grade fever,

night sweats, weigh loss, anorexia, malaise

Night cries

Pain limping, deformity, fulness around hip

joint

Tuberculosis of the
Hip Joint

Stage I : tubercular synovitis

Stege II : early arthritis

Stage III : advanced arthritis

Stage IV : advanced arthritis with subluxation

or dislocation

Tuberculosis of the
Hip Joint

Treatment

Children : traction

Surgery : if respon to the conservative treatment

is not favorable

Osteotomy

Arthrodesis

Excisional arthroplasty

Tuberculosis of the
Knee Joint

3rd commond site for osteoarticular TB

Infection start in the synovium or in subchondral

( distal femur, proximal tibia or patella)

Tubercular synovitis : synovial membrane gets

congested, edematous and studded with
tubercles, pinkis-blue or pinkis-gray

Joint fluid : increased, serous, opalescent, turbid,

yellowish

Tuberculosis of the
Knee Joint

The tuberculous granulation likes

pannus erodes the articular
margin

Knee show swelling filling up all

parapatellar fossae

The thickened of synovium gives

boggy (doughy or semielastic)
feel best palpated at medial
side

Tuberculosis of the
Knee Joint

Movement grossly restricted

painfull, muscle spasm, contrcted
hamstring leg pulled into a
deformity flexion, posterolateral
subluxation, external rotation,
abduction

Tuberculosis of the
Knee Joint
Treatment

Anti tubercular drugs

Traction prevent and

correct deformity

Operative

Synovectony

Arthrodesis

Arthroplasty

Thanks