Tuberculosis in orthopaedics

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Tuberculosis can affect all bones and joints. The spine is affected in 50% of all cases. It affects all ages but commoner in the extremes of age. May co-exist with pulmonary TB in some cases and also in HIV positive patients.

There may be a positive history of contact with a TB infected patient.

Cause

  • Mycobacterium tuberculosis 
  • Mycobacterium africanum 
  • Mycobacterium bovis

Symptoms

  • Pain especially at night
  • Swelling
  • Deformity
  • Night sweats
  • Low grade fever
  • Chronic cough
  • Weight loss

Signs

  • Swelling
  • Tenderness 
  • Deformities
  • Discharging sinuses
  • Cold abscesses
  • Muscle wasting

Investigations

  • Chest X-Ray to rule out pulmonary TB
  • X-ray of the suspected part
  • Sputum/gastric washings for AFBs
  • FBC, ESR
  • MRI of suspected parts (if available) 
  • Bone and soft tissue biopsy for culture and histology
  • Mantoux test 

TreatmentTreatment Objectives

  • Eradicate infection
  • Prevent and correct deformity
  • Prevent stiffness

Non-pharmacological treatment

  • Physiotherapy
  • Splints/corsets/body jackets
  • Draining of abscesses 
  • Debridement
  • Arthrodesis 

Pharmacological treatment 

For bone and joint tuberculosis

(See section on ‘Tuberculosis’)

For pain relief 

Evidence Rating: [B] see section on pain relief in 'Cellulitis' 

Referral Criteria

Refer to appropriate specialist as soon as diagnosis is made.