Tuberculosis of the Musculoskeletal System

Description: Tuberculosis remains a major source of morbidity and mortality world- wide, and orthopaedic surgeons working in developing nations, especially in South East Asia, are likely to encounter patients with osteoarticular manifestations of the disease. Chemotherapy is effective, and surgery serves as an adjunct for specific indications. Tuberculous osteomyelitis is the least common presentation, and the radiographic features may be confused with a variety of other diagnoses. A biopsy is required, and curettage may be performed in addition to chemotherapy. Bone Grafting is generally not required. The natural history of articular disease evolves over several years from a synovitis to joint destruction, and the prognosis is related to the stage of disease at presentation. In addition to chemotherapy, a synovectomy may be indicated in patients who have synovitis without significant joint destruction. For later stage disease, salvage options include osteotomy, arthrodesis, or prosthetic reconstruction. Approximately 50% of patients will have spinal involvement, and chemotherapy is effective in the majority of cases. The indications for surgery remain somewhat controversial, but may include uncertainty with the diagnosis, lack of response to chemotherapy, profound or progressive neurologic deficit, mechanical instability, or progression of deformity.
David A. Spiegel, M.D.,* Girish K. Singh, M.D.,† and Ashok K. Banskota, M.D.‡ Techniques in Orthopaedics® 20(2):167–178 © 2005