PROGNOSIS IN TUBERCULOSIS OF THE HIP

¹ The Wrightington Hospital, Appley Bridge, near Wigan, Lancashire, England

1. Three hundred and twenty cases of tuberculosis of the hip joint have been analysed and the late results assessed three or more years after discharge from hospital.

2. The primary bone focus involved the acetabulum alone in 39·3 per cent; the acetabulum and femoral head in 34·1 per cent; the head of femur alone in 19·2 per cent, and the femoral neck alone in 7·4 per cent. In 101 cases widespread destruction of the joint had taken place by the time the patient first came under observation.

3. Premature epiphysial fusion round the knee joint of the affected side occurred in 23 per cent of all patients under the age of fifteen years.

4. When hip disease was complicated by multiple foci of active tuberculosis or by secondarily infected abscesses and sinuses, the prognosis was seriously worsened.

5. Significant late deformity occurred in 38·3 per cent of patients discharged with "sound" fibrous ankylosis, and in 60·5 per cent of those with an unstable fibrous ankylosis.

6. Of 187 patients observed for more than three years after discharge from hospital 174 returned to full activity, seven were partly incapacitated and six were totally incapacitated.

7. Analysis of the late results suggests that the prognosis is best when an adequate period of conservative treatment is followed by some form of arthrodesis operation.