Utilization of the Safe Surgical Dislocation Approach in the Surgical Management of Early Hip Tuberculosis

Case Report

Austin J Orthopade & Rheumatol. 2017; 4(2): 1055.

Utilization of the Safe Surgical Dislocation Approach in the Surgical Management of Early Hip Tuberculosis

Mahmoud AN*, Mahran MA, Abdelwahab MR, El- Husseini TF, Osman WS, Abdledayem SM, Tharwat SM and Eid MAM

Department of Orthopedic Surgery, Ain Shams University Hospital, Egypt

*Corresponding author: Ahmed Nageeb Mahmoud. Department of Orthopedic Surgery, Ain Shams University Hospital, Egypt

Received: July 03, 2017; Accepted: August 24, 2017; Published: August 31, 2017


We present a rare clinical case of 24 years old female with chronic unilateral hip sepsis not responding to previous surgical debridement and antibiotics. Radiographic assessment showed a deep acetabular destructive lesion with sequestrum and marked synovial hypertrophy. The surgical hip dislocation approach allowed for establishing the diagnosis of hip tuberculosis, and performing radical surgical debridement.

Keywords: Hip joint infection; Hip tuberculosis; Surgical hip dislocation


While the Osteo-Articular Tuberculosis (OATB) is relatively of rare occurrence in clinical practice, tuberculous arthritis is associated with high risk of severe deterioration of the involved joints. TB of the hip may result in gross deformities, end stage articular cartilage and bone damage, and marked limitation of the patients’ quality of life [1]. Early diagnosis, proper management and careful follow up could preserve the joint function in patients with hip TB.

We present a case of early hip tuberculosis, managed successfully through the safe surgical dislocation approach, as described by Ganz et al. [2]. We believe this surgical approach could be very useful in the management of early stages of hip tuberculosis, as well as in cases of chronic resistant hip sepsis generally, to establish the diagnosis and access a deeply seated septic lesion.

Case Presentation

A female patient, 24 years old, referred to the orthopedic clinic of our university hospital on March 2013 with severe right hip pain and limitation of weight bearing on the right lower limb with a late use of wheelchair during the last 1 week. She gave a history of open surgical debridement for right hip infection twice during the previous 9 months before presentation, with temporary improvement after each surgery. Medical history was positive for asthmatic bronchitis, controlled on anti-asthma medications.

Positive findings on local examination included right hip anterolateral scar, loss of weight bearing on right lower limb; local tenderness and marked limitation of the right hip range of motion due to pain. The pre-operative Oxford hip score was 52.

Laboratory investigations included a serum Hemoglobin of 10.8 gm/dl, ESR 1st hour of 60 and CRP of 27 (normal reference up to 5). Available results of the previous surgical biopsies showed no bacterial growth. A trial for hip needle aspiration revealed a limited amount of serous fluid that was negative for bacterial growth. A routine pre operative viral markers check for hepatitis and HIV were negative.

Chest radiograph showed a non specific accentuation of bronchovascular markings (Figure 1A). Plain radiographs of the pelvis and hips (Figure 1B, C) showed a radiolucent oval shadow, occupying the lower portion of the right acetabulum and obscuring the tear drop. Hip CT scan (Figure 1D, 1E) showed a destructive lesion in the posterior column of the right acetabulum, invading into the hip joint cavity and the posterior extra articular space. A sequestrum was noticed inside the posterior column. Hip MRI (Figure 1F) Showed marked synovial thickening, posterior column hyper echoic lesion and mild joint effusion.