THE MANAGEMENT OF THE TUBERCULOUS HIP JOINT

¹ Edinburgh, Scotland

It is Obvious to us all that the handling of infective granulomatous diseases lies in the realms of sociology and preventive medicine. The day of this is still far distant, and it is our duty with present-day knowledge and experience to consider the future of this lesion.

Chemotherapy for the Mycobacterium tuberculosis has been long enough in general use for us to accept it as the most useful adjunct to surgery, the principles of which, in turn, must be modified and advanced so that its properties are fully utilized in the treatment of this incapacitating condition. Antibiotics may be expected to shorten the course of the disease. Rigid immobilization for a long time is probably no longer essential, and one hopes that the unfortunate effects of immobilization, such as renal calculi, osteoporosis, and premature epiphyseal closure, leading to a woefully short extremity, will also become things of the past. I fully expect that the bacteriologist and the biochemist will give us other chemotherapeutic agents of greater bacteriostatic and penetrating properties, and that our surgical treatment will correspondingly advance, resulting in more mobile hips. There will, however, often be some derangement in the usual architecture of the surfaces of this weight-bearing joint, because most tuberculous lesions heal by fibrous tissue or recalcification, without regeneration of the original tissues. The complication of osteo-arthritis is thus likely to arise with its own peculiar difficulties in treatment, and arthroplasties will have to be carried out at a later stage of life. Most of us will be ready and pleased to treat this complication when it arises, after the patient has had for several years the use of a functioning hip joint.

To achieve bony ankylosis of a tuberculous hip joint (particularly in the advanced intra-osseous type of lesion) must still be our aim and the method of choice because of its long proved efficacy. However, I do suggest that now, more than ever, we must strive for early diagnosis of the lesion by biopsy (with its concomitant decompression of the tuberculous lesion of the hip joint) so that the patient is left with a functioning and mobile hip.

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