OSTEO-

ARTICULAR
TUBERCULOSIS
Dr. Chandrakant Nallulwar
Prof. & H.O.D.
Dept. of Orthopaedics
SDMCMSH


Epidemiology
1. Commonest through out the world
2. Decline in last 60 -70 years because of
effective public health programme and
advanced chemotherapy
3. Increase in last two decades
4. Eg.extra pulmanry tuberculosis has
increased a) population
b) I.V drug abusers
c) Emerging AIDS
PATHOLOGY
Causative org- Mycobacterium
tuberculosis
acid fast bacillus- human
bovine
Chronic granulomatus lesion with
caseating necrosis
Primary complex-Mantoux test,
heaf test

Secondary spread
1. Miliary tuberculosis
2. Meningitis
Tertiary 5 % of TB patients
have bone & joint involvement
Multiple lesions found in 1/3
patients


Synovial tissue involvement
earlier to joint involvement
Tuberculosis granuloma chronic
inflamatory reaction
Epitheloid & multi nucleolated
giant cells surrounding central
caseation due to necrosis with
round cell infiltration at periphery



Coalition of small lesions creates
large yallowish mass converting
in cold abcess
Containing pus & necrotic bone
material
Bone lesion spreads in to the
joints as epiphyseal cartlage is no
barrier for invasion & joint gets
affected
In vertibral bodies & short-long bones
osteo-lytic lesion remains without
periosteal reaction known as
tuberculous osteomylitis or
tuberculous ductilitis
Synovial hypotrophy leads to swelling
and effusion leading to subchondral
bone erosion
Subsequently cartilage gets eroded

Increased vascularity causes
osteoporosis
The caseation & infection
continues develops in to cold
abscess
This may break the skin &
discharging sinus develops

Damaged articular cartilage heals
by fibrosis leading to fibrous
ankylosis & progressive joint
deformity
The lesion may remain dormant
for many years & may get
reactivated after many years of
stopping the treatment
Clinical Features
Painful swelling of a joint
Fever, loss of wt., loss of apetite
Loss of wt
Night cries
Restriction of joint movements
Deformity
Loss of function with wasting of
surrounding muscles

Investigations
Plain X-ray
- Reduction of joint space
- Surrounding osteoporosis
- Soft tissue swelling
- Wash out appearance of
bone
- Osteolytic lesion in the
bone
due to osteoclastic activity

Spine - Reduction in disc space
- Collapse of vertibra
- Bird nest abscess

X-ray chest, C. T. & MRI

Investigations
Haemogramme
C. R. P.
Mantoux test
Synovial fluid examination
Synovial biopsy

Differential Diagnosis
Transient synovitis of hip
Mono-articular rheumatoid
arthritis
Haemophilic arthritis
Sub-acute septic arthritis
Bruselosis

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