From the Guidelines
Tuberculosis (TB) can cause hip joint pain, and the connection between TB and hip pain exists due to the bacteria's affinity for the hip joint, which can lead to tuberculous arthritis or TB hip, a condition that requires prompt medical evaluation and treatment to prevent permanent joint damage. The infection typically occurs when TB bacteria from the lungs travel through the bloodstream to the hip joint, causing gradual destruction of the joint, leading to persistent pain, limited mobility, stiffness, and sometimes a limp 1. TB hip is more common in developing countries and among immunocompromised individuals.
Diagnosis and Treatment
The diagnosis of TB hip can be challenging, and imaging modalities such as radiographs, CT, MRI, and ultrasound can be used to evaluate hip pain and detect osseous and soft tissue abnormalities 1. Treatment requires a standard anti-TB medication regimen including isoniazid, rifampin, ethambutol, and pyrazinamide for 2 months, followed by isoniazid and rifampin for an additional 7-10 months, totaling 9-12 months of therapy. Some cases may require surgical intervention if there is significant joint damage.
Importance of Early Diagnosis
Early diagnosis is crucial to prevent permanent joint damage, so anyone with persistent hip pain and risk factors for TB should seek medical evaluation promptly. The use of diagnostic and therapeutic injections, such as intra-articular injections, can also be useful in confirming the location of pain and helping in its control for a short period 1.
Key Points
- TB can cause hip joint pain due to the bacteria's affinity for the hip joint
- Prompt medical evaluation and treatment are necessary to prevent permanent joint damage
- Imaging modalities such as radiographs, CT, MRI, and ultrasound can be used to evaluate hip pain and detect osseous and soft tissue abnormalities
- Treatment requires a standard anti-TB medication regimen, and some cases may require surgical intervention if there is significant joint damage.
From the Research
Correlation between TB and Hip Joint Pain
- Tuberculosis (TB) of the hip joint is a debilitating disease that can result in severe joint destruction, eventually leading to painful arthritis of the hip 2.
- The correlation between TB and hip joint pain is significant, as TB of the hip constitutes approximately 15% of all cases of osteoarticular tuberculosis, with the common age of presentation being in the second and third decades 3.
- Hip joint pain is a common symptom of TB of the hip, and if left untreated, can lead to progressive destruction of the hip joint 3.
Diagnosis and Treatment
- Early diagnosis and treatment of TB of the hip are crucial to prevent joint destruction and improve outcomes 3, 4.
- Diagnostic modalities such as ultrasonography, magnetic resonance imaging, and synovial fluid aspiration can be used to diagnose TB of the hip, especially in early stages when plain X-rays are negative 4.
- Treatment of TB of the hip typically involves a combination of anti-tubercular drug therapy, traction, and supervised mobilization, with surgery being considered in cases where conservative treatment is not effective or in advanced stages of the disease 3, 4, 2.
Surgical Options
- Total hip arthroplasty (THA) is a surgical option for patients with advanced arthritis and healed TB infection, offering a painless and mobile joint with good functional outcome 2.
- However, the timing of surgery and the risk of disease reactivation are important considerations in patients with active TB 2, 5.
- Studies have shown that THA can be safely performed in patients with quiescent or active tubercular hip arthritis, with a low risk of reactivation 2, 5.