Q112369523
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PURPOSE OF THE STUDY: Tuberculosis (TB) in a joint region presents high risk of damage to the joint. Consequences of a late diagnosis and inadequate therapy may be serious particularly in the large joints of lower extremities. Tuberculosis of knee and hip joints accounts for about 25% to 35% of osteoarticular tuberculosis (OAT). The aim of this study was to evaluate the objective and subjective results of tuberculosis treatment in knee and hip joints. MATERIAL AND METHODS: Of 258 OAT patients treated at the Specialised Treatment Centre Jevíčko between January 2005 and September 2012, tuberculosis of the hip joint was diagnosed in 31 patients in whom three hips were treated by incision and drainage and 10 by total hip replacement; 18 patients had tuberculosis of the knee joint with the following treatment: puncture in seven knees, incision and drainage in eight, excochleation of a tuberculous focus in the proximal tibia in two, removal of a bursa in one, arthrodesis in four and total knee replacement in four patients. The patients continued to be followed up at the Jevíčko Centre. The scale of 1 to 5 (best to worst) was established for evaluation of objective and subjective results of the treatment. The data were analysed using the basic statistical characteristics and compared. RESULTS: The objective evaluation was better for the hip joint; the sums of relative frequencies of marks 1 to 3 were 72.22% in the knee and 80.65% in the hip. In the knee more than 50% of the cases fell in the interval <1.304; 4.252>, in the hip this was <1.296; 3.672>. The hip joint was better subjectively evaluated, it had a higher sum of relative frequencies of marks 1 to 3, i.e., 96.77% as compared with 88.89% for the knee. In the knee more than 50% of the cases had marks in the interval <0.767; 3.122>; in the hip this was <0.869; 2.680>. The hip joint was better evaluated both objectively and subjectively. DISCUSSION: An early diagnosis allows for the treatment of synovitis, which has a better prognosis than an arthritic disease. The subjective perception of treatment results showed a better evaluation than its objective correlate. Many patients were satisfied with the results, even with an immobilised joint (in arthrodesis). Total joint replacement in OAT patients does not always provide expected results in either knee or hip joints. Arthrodesis also has its indications related to health condition, age and social status of the patient. In periprosthetic TB infections, a careful consideration should be given to removal of the prosthesis and its re-implantation in relation to all circumstances associated with each particular case. CONCLUSIONS: Tuberculosis of large weight-bearing joints is a rare entity in the countries with low TB prevalence, including the Czech Republic. It is necessary to pay attention to diagnosis and therapy and make them more effective even at higher costs associated with total hip replacement in TB or post-TB patients in order to maintain or restore joint function. At the time of borders open for citizens from countries with higher TB prevalence, the diagnosis of OAT should be considered.
- MeSH
- burzitida diagnóza epidemiologie MeSH
- časná diagnóza MeSH
- dospělí MeSH
- drenáž metody MeSH
- kolenní kloub * MeSH
- komorbidita MeSH
- kyčelní kloub MeSH
- lidé MeSH
- náhrada kyčelního kloubu MeSH
- prognóza MeSH
- rozsah kloubních pohybů MeSH
- tendinopatie diagnóza epidemiologie MeSH
- totální endoprotéza kolene MeSH
- tuberkulóza osteoartikulární diagnóza epidemiologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- anglický abstrakt MeSH
- časopisecké články MeSH
- hodnotící studie MeSH
Tuberculous hip arthritis accounts for about 15 % of all orthopaedic forms of tuberculosis and ranks third after spinal and knee joint tuberculosis. The aim of this study was to present the results of total hip arthroplasty (THA) for treatment of post-infectious arthritis or ankylosis, or previous arthrodesis. MATERIAL: A group of patients, 16 women and 10 men, treated at the 1st Department of Orthopaedics, 1st Faculty of Medicine, Charles University in Prague, between 1980 and 2007, was evaluated. All patients had tuberculous hip arthritis in their history and subsequently underwent THA. The average age at the time of THA was 65 years. METHODS: Indications for THA following tuberculous coxitis were secondary post-infectious arthritis in 20 patient, ankylosis (fibrous or osseous) in four and conversion from arthrodesis in two. Intra-operative samples were taken for microbiological examination, polymerase chain reaction (PCR) and histological examination. Anti-tuberculous drugs (rifampicin and isoniazid) and cephalosporin were administered intra-operatively following the sample collection and continued post-operatively. Cephalosporin was discontinued on post-operative day 11, rifampicin and isoniazid were administered for further 3 to 5 months with regular laboratory tests. RESULTS: The average post-operative values for flexion ranged from 0 to 90 degrees, for abduction from 0 to 35 degrees and for both internal and external rotation from 0 to 30 degrees. At the end of treatment all patients walked without aid and with full weight-bearing on the operated leg. No complications were recorded. Intra-operative findings of microbiological, PCR and histological examinations were negative. No recurrent tuberculous disease was found. DISCUSSION: A total joint replacement in any post-infectious condition is a complex issue. The average time between achieving a steady state o tuberculous arthritis and the THA procedure was approximately seven years. The outcome was evaluated as good by 75 % of the patients, who would be willing to undergo the surgery again.The clinical picture and radiographic and laboratory findings were within norms at regular follow-ups, which is in agreement with the literature data. Our system of intra- and post-operative administration of anti-tuberculous drugs and antibiotics proved very efficient. CONCLUSIONS: In contrast to arthrodesis or Girdlestone resection arthroplasty, THA results in a marked improvement of painless joint motion. Before any patient is indicated for THA, a thorough medical history with laboratory, internal and pulmonary (including heart and lung radiographs) examination is necessary. When there is more than one tuberculous disease in the patient's medical history, other organ systems such as urinary or reproductive tracts should also be examined. In addition to conventional radiography, examination by computed tomography or magnetic resonance imaging is indicated. The priority is an individual approach of the phthisiology orthopaedist to the indications ensuing from this comprehensive examination, with assessment of both physical and psychic state of the patient in view of post-operative rehabilitation.
Tuberkulózní zánět pohybového aparátu - ortopedická tuberkulóza patří mezi zánětlivá specifická onemocnění, u nichž na počátku onemocnění právě základní zánětlivé faktory, tj. sedimentace erytrocytů, krevní obraz - leukocyty a C reaktivní protein jsou na rozdíl od nespecifického zánětu na počátku onemocnění ve vysokém procentu jen mírně zvýšené, ojediněle i negativní. Uvedená fakta právě v rámci diferenciální diagnózy vedou velmi často k falešnému závěru. V našem příspěvku jsme hodnotili mimo jiné i tyto základní zánětlivé faktory na počátku onemocnění, během terapie i po zhojení tuberkulózního zánětu v souboru 140 dokumentovaných pacientů s ortopedickou tuberkulózou v letech 1980-2006.
Tuberculous inflammation of the locomotion system, i.e. orthopaedic tuberculosis, falls within the category of specific diseases in which the laboratory inflammatory factors, i.e. erythrocyte sedimentation rate, C-reactive protein, blood count–leukocytes, are minimally altered or negative. In differential diagnostics, these facts could result in false conclusions. In our study of documented 140 cases between 1980/2006 we have reviewed these inflammatory factors at the onset of the disease, during therapy and after the completion of the healing process.
V našem příspěvku uvádíme neobvyklosti, se kterými se lze per- či pooperačně setkat při rutinní indikaci k implantaci totální endoprotézy (dále TEP) kyčelního kloubu, když kompletní anamnéza (s ohledem na tb) není indikujícím lékařem vedena zcela vyčerpávajícím způsobem. Jedná se o 5 kazuistik, kdy byla indikována TEP při nebo po nediagnostikované tuberkulózní artritidě či tuberkulózní zánět (,,spící BK“) se aktivoval i s dlouhým časovým odstupem po implantaci TEP.
In the study we report irregularities that may be detected intraoperatively or postoperatively in routine indication for total endoprosthesis implantation (TEP) in the hip joint, when a medical history, administered by an indicating physician, is not sufficient or complete (concerning tuberculousis). In the above mentioned five case reports, total endoprosthesis was indicated at or after the previously non-diagnosed tuberculous arthritis or tuberculous inflammation /dormant Koch´s bacillus/ appeared even a long time after TEP implantation.
- MeSH
- anamnéza MeSH
- artritida diagnóza etiologie komplikace MeSH
- dospělí MeSH
- lidé MeSH
- magnetická rezonanční tomografie využití MeSH
- ortopedické výkony metody trendy MeSH
- peroperační komplikace etiologie chirurgie terapie MeSH
- pooperační komplikace etiologie chirurgie terapie MeSH
- senioři MeSH
- tomografie emisní počítačová využití MeSH
- totální endoprotéza kolene metody využití MeSH
- tuberkulóza diagnóza komplikace MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Tuberculous hip arthritis ranks third in the classification of orthopedic tuberculosis, after tuberculosis of the spine and knee joint. It accounts for about 15 % of all orthopedic tuberculosis. The aim of this paper is to demonstrate the etiology, clinical presentation and forms of disease on the case reports of six patients. The scope of disease is wide - from a mild reversible synovial form, then fibrous or bone ankylosis, to severe destruction of the hip with subluxation or dislocation, pseudoarthrosis or chronic arthritis with a fistula. The wide diversity of clinical findings and difficulties is making diagnosis are often responsible for a late start of therapy. However, only an early and adequate treatment permits the prevention of irreversible damage to the hip joint or further complications.
- MeSH
- artritida etiologie klasifikace mikrobiologie MeSH
- kyčelní kloub mikrobiologie patologie MeSH
- lidé MeSH
- stupeň závažnosti nemoci MeSH
- tuberkulóza osteoartikulární mikrobiologie patologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- kazuistiky MeSH
Ve sledovaném souboru 140 nemocných s prokázanou ortopedickou tuberkulózou (dále Otb) v letech 1980 – 2005 jsme hodnotili přítomnost ať již předchozí anamnestické, či současně probíhající plicní formy tuberkulózy a rovněž ve shodném sledu jinou mimoplicní lokalizaci. Výsledkem jsme chtěli ověřit tzv. návaznou sekundárnost Otb. Je nutné zde připomenout, že časový úsek od primoinfektu do vzniku jiné orgánové tuberkulózy se v literatuře uvádí až 25 let i více. Téměř 50% nemocných (67 pacientů) uváděného souboru mělo v anamnéze či současně plicní lokalizaci tuberkulózy, další mimoplicní tuberkulózu (dále Mtb) - urologická, gynekologická či neurologická (meningitis) byla přítomna ve 34 případech.
In the group of 140 patients with proved orthopedic tuberculosis between 1980-2005 we reviewed the preexistent or current pulmonary form of tuberculosis or extrapulmonary tuberculosis. Our task was to prove so called „bound secondariness" of ortopaedic tuberculosis. It is important to emphasize that in the literature the interval between primary infection and organic tuberculosis was usually 25 years or more. Almost 50 % of our patients (67 cases) had anamnestic or current pulmonary tuberculosis. Extrapulmonary tuberculosis in other locations - urological, gynaecological or neurological (meningitis) - was found in 34 cases.
Cílem uváděného sdělení je představit současnou organizaci a náplň práce ambulance pro ortopedickou tuberkulózu v Praze, zhodnocení stavu v otázce diagnostiky v rámci diferenciální diagnózy a rovněž poukázat na nedostatky a problémy, se kterými se i dnes setkáváme jak po stránce organizace péče o nemocné, tak při diagnostice i terapii ortopedické tuberkulózy. Součástí příspěvku je komplexní hodnocení souboru 140 nemocných ve sledovaném období 25 let s ohledem na uvedené aspekty.
The author presents today's organisation and the scope of employment of the specialized outpatient clinic for orthopaedic tuberculosis in Prague to evaluate today's diagnostics of this disease, and to mention some problems which we can see in the organisation of this specialized health care and in diagnostics and therapy of orthopaedie tuberculosis. The group of 140 patients with orthopaedic tuberculosis observed in 25 years is analysed concerning the diagnostic methods and treatment.
