Bone and Joint Tb

8/11/2019 Bone and Joint Tb

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OSTEO-

ARTICULAR

TUBERCULOSISDr. Chandrakant Nallulwar

Prof. & H.O.D.

Dept. of Orthopaedics

SDMCMSH


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Epidemiology

1. Commonest through out the world

2. Decline in last 60 -70 years because ofeffective public health programme and

advanced chemotherapy3. Increase in last two decades

4. Eg.extra pulmanry tuberculosis has

increased a) population b) I.V drug abusers

c) Emerging AIDS


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PATHOLOGY

Causative org- Mycobacterium

tuberculosis

acid fast bacillus- human

bovine

Chronic granulomatus lesion with

caseating necrosisPrimary complex-Mantoux test,

heaf test


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Synovial tissue involvement

earlier to joint involvementTuberculosis granuloma chronic

inflamatory reaction

Epitheloid & multi nucleolated

giant cells surrounding central

caseation due to necrosis withround cell infiltration at periphery


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Coalition of small lesions creates

large yallowish mass convertingin cold abcess

Containing pus & necrotic bonematerial

Bone lesion spreads in to the

joints as epiphyseal cartlage is no

barrier for invasion & joint gets

affected


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In vertibral bodies & short-long bones

osteo-lytic lesion remains withoutperiosteal reaction known as

tuberculous osteomylitis or

tuberculous ductilitisSynovial hypotrophy leads to swelling

and effusion leading to subchondral

bone erosionSubsequently cartilage gets eroded


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Damaged articular cartilage heals

by fibrosis leading to fibrousankylosis & progressive joint

deformity

The lesion may remain dormant

for many years & may get

reactivated after many years ofstopping the treatment


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Clinical Features

Painful swelling of a joint

Fever, loss of wt., loss of apetite

Loss of wt

Night cries

Restriction of joint movements

DeformityLoss of function with wasting of

surrounding muscles


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Spine - Reduction in disc space

- Collapse of vertibra

- Bird nest abscess

X-ray chest, C. T. & MRI


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Investigations

Haemogramme

C. R. P.

Mantoux testSynovial fluid examination

Synovial biopsy


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Differential Diagnosis

Transient synovitis of hip

Mono-articular rheumatoid

arthritis

Haemophilic arthritis

Sub-acute septic arthritisBruselosis


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THANK YOU

Bone and Joint Tb

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