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Copyright: © 2017 Lamine S, et al.
Research Article Journal of Orthopedics, Rheumatology and Sports Medicine Open Access
Received Date: March 21, 2017, Accepted Date: May 26, 2017, Published Date: June 03, 2017.
*Corresponding author: Lamine Sarr, BP 3001 Avenue Pasteur Dakar, Senegal, Tel: 221-776-528-823, E-mail: drlaminesarr@yahoo.fr.
Figure 1: Knee TB with lateral gastrocnemius muscle cold abscess (A) Gonarthrosis SAZAKI stage IV in a 23 years old un patient (B).
Figure 3: TB Arthritis of the Hip with bilateral head of femur necrosis (A) Treated by chemotherapy and bilateral Total Hip Prosthesis (B).
Scan was performed in three patients. It helped in defining further with the national protocol and adjuvant analgesic therapy. In
extent of joint destruction. The ultrasound was performed in four eleven patients, in addition to anti-tuberculosis chemotherapy,
patients. The diagnosis was confirmed bacteriologically and/or surgery was performed. In six patients, it consisted in debridement
histologically in all cases. A confirmation of acid fast bacillus (AFB) accompanied with plaster of Paris (POP) immobilization or soft
from any body fluid or tissue is the gold standard for the diagnosis immobilization with removable splints (Figures 2,3,5). In case of
of tuberculosis. A Ziehl-Nelsen stain revealed AFB in six patients. ankle tuberculosis, external fixation after debridement has been
Different culture methods such as Lowenstein-Jensen medium can used. In three cases, a joint replacement therapy was performed;
be used for confirming diagnosis of mycobacterium tuberculosis. that is the Total Hip Replacement (Figures 3,4). In one female
In nine patients, cytological examination of the samples showed patient, the joint replacement therapy was done concomitantly
the existence of typical epithelioïd giant cell granuloma. The with the debridement (Figure 4). All patients were declared healed
Chest X-ray was systematically requested in all patients and three of tuberculosis. The mean follow-up time for eleven patients was 44
patients presented tuberculosis caverns. One patient presented months (interval: 17 and 127). Anatomical results were different.
active miliary tuberculosis and one had a spine localization. All In the shoulder joint, we had a joint space narrowing with humeral
patients received anti-tuberculosis chemotherapy in accordance head necrosis at persistence of multiples metaphyseal lacunar
Citation: Lamine S, Massadiami S, Daniel SA, Moustapha NM, Valerie KCA, et al. (2017) Extra-Spinal Tuberculosis Arthritis: Page 2 of 6
Diagnosis and Treatment Patterns. J Orth Rhe Sp Med 2(2): 116.
J Orth Rhe Sp Med ISSN: 2470-9824 Vol. 2. Issue. 2. 35000116
lesions (Figure 6). In three cases of Total Hip Replacement, the Murley Shoulder outcome Score has been used as the measure for
implants were in place without any sign of prosthetic loosening nor assessing the outcomes of the treatment of shoulder tuberculosis.
tuberculosis reactivation. Four remaining cases of hip tuberculosis It is the recommended scoring system of the European Society
were at the stage of coxarthrosis (3 cases) and septic dislocation of Shoulder and Elbow Surgery (ESSE). It is poor with the score
of the hip (1 case). In case of knee tuberculosis, we had globally at 65 (Figure 6). The Postel-Merle d’Aubigné (PMA) score in case
joint space narrowing. In the ankle joint, we had bone fusion with of Total Hip replacement therapy was excellent. In case of knee
tibio-talar joint arthrodesis. At the function level, the Constant- tuberculosis, there is persistence of residual mechanic pain with
Citation: Lamine S, Massadiami S, Daniel SA, Moustapha NM, Valerie KCA, et al. (2017) Extra-Spinal Tuberculosis Arthritis: Page 3 of 6
Diagnosis and Treatment Patterns. J Orth Rhe Sp Med 2(2): 116.
J Orth Rhe Sp Med ISSN: 2470-9824 Vol. 2. Issue. 2. 35000116
Figure 6: TB Arthritis of the shoulder (A: TB Arthritis with humeral head necrosis; B: Intra-operative Caseum; C and D: Shoulder fonctions after healing)
different movement restriction of the joint. In the ankle, the the agent or history of trauma should undergo microbiological or
painless plantigrade walk is possible without limbing. The patient histological tests for tuberculosis which remains the gold standard in
with elbow and wrist localisation disappeared. the diagnosis of tuberculosis. Tuberculosis, once a disease confined
to undeveloped or developing nations is currently in resurgence,
Discussion which is attributable to pandemic human immunodeficiency virus
Our study of fourteen cases in thirteen patients seems to make (HIV) infection and immigration from endemic areas [5]. It is an
the extra-spinal tuberculosis arthritis rare. However, these are infection of the hip and knee joints essentially of the young adult
visible parts of the iceberg [2–4]. The diagnosis of tuberculosis joint male. This observation was confirmed in the literature [2,3,5,6]. The
arthritis is delayed due to lack of awareness, insidious in onset, diagnosis of a Tuberculous arthritis is difficult because it can mimic
lack of characteristic early radiographic findings and often lack of an early mono-articular chronic inflammatory rheumatism, a form
constitutional or pulmonary involvement. A high index of suspicion of torpide bacterial arthritis of banal germ, a fungal arthritis, other
is necessary, especially in the context of persistent mono-arthritis in granulomatous synovitis and pigmented villo-nodular synovitis.
a susceptible host. The immunocompromised individuals, elderly or [3,7–9]. The shoulder tuberculosis had a pseudo-tumor aspect. We
children in close contact to tuberculosis or patient who underwent often dispose an x-ray image of lytic bone without any reaction thus
treatment with corticoid and /or immunosuppressive and biologic also revealing an infection with the bacillus of Hansen or a tumor.
Citation: Lamine S, Massadiami S, Daniel SA, Moustapha NM, Valerie KCA, et al. (2017) Extra-Spinal Tuberculosis Arthritis: Page 4 of 6
Diagnosis and Treatment Patterns. J Orth Rhe Sp Med 2(2): 116.
J Orth Rhe Sp Med ISSN: 2470-9824 Vol. 2. Issue. 2. 35000116
All our cases had a bacteriological or histological confirmation surgeon to pay attention to diagnosis and therapy and make
after the diagnosis was suspected on the basis of chronic and them more effective even at higher costs associated with total hip
destructive osteo-articular lesions; classical features on medical replacement in tuberculosis or post-tuberculosis patients in order
imaging (radiography, CT), increased CRP, phlyctenular standard to maintain or restore joint function.
tuberculin skin test (TST) [5,7,10]. The suspicious diagnosis has
often been intra-operative (case of arthritis tuberculosis of the Conflict of Interest
shoulder and one case of coxalgia) by the discovery of the caseum None declared.
during the debridement. The diagnosis of arthritis tuberculosis
is as challenging as the treatment. Thus, the mainstay treatment References
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Citation: Lamine S, Massadiami S, Daniel SA, Moustapha NM, Valerie KCA, et al. (2017) Extra-Spinal Tuberculosis Arthritis: Page 5 of 6
Diagnosis and Treatment Patterns. J Orth Rhe Sp Med 2(2): 116.
J Orth Rhe Sp Med ISSN: 2470-9824 Vol. 2. Issue. 2. 35000116
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*Corresponding author: Lamine Sarr, BP 3001 Avenue Pasteur Dakar, Senegal, Tel: 221-776-528-823, E-mail: drlaminesarr@yahoo.fr.
Received Date: March 21, 2017, Accepted Date: May 26, 2017, Published Date: June 03, 2017.
Copyright: © 2017 Lamine S, et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original work is properly cited.
Citation: Lamine S, Massadiami S, Daniel SA, Moustapha NM, Valerie KCA, et al. (2017) Extra-Spinal Tuberculosis Arthritis: Diagnosis and Treatment Patterns.
J Orth Rhe Sp Med 2(2): 116.
Citation: Lamine S, Massadiami S, Daniel SA, Moustapha NM, Valerie KCA, et al. (2017) Extra-Spinal Tuberculosis Arthritis: Page 6 of 6
Diagnosis and Treatment Patterns. J Orth Rhe Sp Med 2(2): 116.