Tuberculosis of Bones and Joints

TUBERCULOSIS OF BONES
AND JOINTS
General surgery department of SGMU
Lecturer –ass. Khilgiyaev R.H.
ethyology
 Caused by Mycobacterium tuberculosis, tuberculosis

most commonly affects the lungs, lymph nodes and
serous membranes, the bones and joints being the last
to be involved with the incidence as low as about 10%.
localization
• The major sites of osseous and articular

tuberculous lesions include the epiphyses of
the long bone shafts, bodies of the short
bones: f.e. vertebrae and diaphyses of the
digital phalanges.
• Analogically, this type of tuberculosis falls
into the major forms:
• •tuberculous spondylitis, or spinal TB (40%);
• •tuberculous coxitis, or hip jojnt TB (20%);
• •tuberculous gonitis, or knee joint TB (15- 20%)
Specific inflammatory reaction
 Tuberculosis of the bone and joints is usually due

to a secondary TB infection, which Implies its
lymphohaematogenous spread from the primary
pulmonary focus or that of other organs.
 Mycobacterium induce specific inflammatory
reaction within the bone marrow of epiphyses,
the site known to have a slower blood flow.
 This results in primary ostiitis of tuberculous
osteomyelitis.
caseous necrosis
 The initial tuberculous focus undergoes

caseous («cheese-like») necrosis around
which further tubercles form to merge with
the initial focus.
 Subsequently, granulation occurs which, in
turn, is subject to necrosis.
 This leads to sequestration: the bony tissues
involved in the necrosis become completely
separated from the underlying bone.
TB synovitis
 The progression of tuberculous inflammation

into the joint forms an articular sac with
subsequent caseous necrosis of the joint
cartilage and contiguous osseous tissues.
 Primary synovial tuberculosis (TB synovitis)
only occurs in about 5% of cases, with a
favourable outcome as it is unlikely to cause
the damage to the joint ends of the bones.
pathogenesis of tuberculosis of the

bone and joints
 involves the three stages:

 stage 1 – prearthritis- formation of the bone
focus in the epiphysis around the joint;
 stage 2 - arthritis - extension of the process to
the joint with resultant secondary arthritis;
 stage 3 - post-arthritis- stabilization of the
disease with the evidence of its
complications.
clinical picture:
1. Complaints
• loss of appetite;
• easy fatigability;
• difficult walking;
• weight loss;
• Iow grade fever.
2. History of present illness
• impaired limb function followed by pain

on moving (most often in the back, hip and knee
joints) which, as a rule, worsens on walking and
bending
3. Family and past medical

history
• evidence of tuberculosis in the family (e.g,
parents);
• contacts with contagious tuberculosis
cases
• provoking factors (e.g. trauma);
• history of an infection.
4. Physical examination
• weight loss;
• muscle atrophy at the limb affected;
• skin and mucosal pallor.
X-ray of bones (to detect changes in the

spongy bone tissues at metaphyses):
• osteoporosis;
• foci of sequestration coupled with clear
areas in the form of a soft shadow («a piece of
melting sugar» sign);
• widening of the joint space followed by its
narrowing;
• notching of joint cartilaginous and
osseous tissues;
• osteosclerosis and periostitis are usually
absent.
Different diagnostic
 It is noteworthy that tuberculosis of the

bones has to be differentiated from chronic
haematogenous osteomyelitis
Treatment
 Involves both conservative and surgical

methods.
 Antibacterial chemotherapy requires the use
of specific antituberculous antibiotics
 Affected organ must be immobilized , which
prevents bone deformation and favours
healing.
 Splints, jackets and dressings are applied
Surgery –
Is one of the major modalities in complex management
 Radical operations:
 Necrectomy, or excision of periarticular
tuberculous foci from the vertrebral bodies and
the bone epiphyses;
 Bone resection, or removal of the joint ends of
bones destructed
Ancillary operation:
 Arthrodesis (i.e. forming artificial ankylosis),

or the immobilization of the joint, espescially
in the case of tuberculous spondylitis
(spondylodesis) when the vertebral column is
fixed using bone transplantants or metallic
constructions
 Laminectomy is indicated in compression of
the spinal cord
Reconstructive operation:
 Osteotomy and joint trepanation to restore

the organ’s (limb, joint, spine) function after
the inflammation has been eliminated

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TUBERCULOSIS OF BONES

 Caused by Mycobacterium tuberculosis, tuberculosis

• The major sites of osseous and articular

Specific inflammatory reaction

 Tuberculosis of the bone and joints is usually due

 The initial tuberculous focus undergoes

 The progression of tuberculous inflammation

pathogenesis of tuberculosis of the

 involves the three stages:

2. History of present illness

• impaired limb function followed by pain

3. Family and past medical

X-ray of bones (to detect changes in the

 It is noteworthy that tuberculosis of the

 Involves both conservative and surgical

 Arthrodesis (i.e. forming artificial ankylosis),

 Osteotomy and joint trepanation to restore

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