March 2019 digital v1

TUBERCULOSIS OF HIP
A 38-year-old gentle man
presented with severe hip
pain, true shortening, all
movements painfully restricted.
ESR was at 70, Mantoux test
positive, CBNAAT test positive,
Histopathology also positive. He
was on bed rest with traction for
2 months and on ATT. Now he is
undergoing ATT.
X-ray pelvis showing both hips
with destruction of right hip
(head of femur and acetabulum).
TUBERCULOSIS OF THE KNEE
32-year-old gentleman, welder by
profession, presented with right knee
pain since 3 yrs. According to his words
the complaint started after a hit to his
knee with an iron bar while working.
In the last one-year period he could
do work only for 4 months (the other
8 months were spent on treatment
from various other health facilities). His
personal history revealed that he has
no diabetes, jaundice, hypertension,
recurrent fever or HIV. The complaint
stated as a sudden onset of pain 3 years
back following hit to an iron rod, with
a swelling disproportionate to the pain.
Now presented with swelling around
right knee. O/E: Patient walks with
antalgic gait, horse shoe swelling around
knee with increased temperature,
patellar tap was present along with
synovial thickening. Fixed flexion
deformity of 20 degrees then flexion
possible up to 90 degrees but with pain.
Clinically a diagnosis of chronic synovitis
was made. The case is interesting for its
3-year duration, and the MRI report of
pigmented villo-nodular synovitis.
THE CASE IS INTERESTING
FOR ITS 3-YEAR DURATION,
AND THE MRI REPORT OF
PIGMENTED VILLO-NODULAR
SYNOVITIS
Investigations
HB: 11.7, TC-4200, P-69%, L-23%, E-6%,
M-2%. ESR-80. RBS: 143mgs, HBS
Ag, HCV, HIV – negative X-ray showed
osteoporosis.
MRI report indicated synovial
thickening, 2 punched out lesions at
Biopsy result of synovectomy specimen.
the femoral condyles, pigmented villo
nodular synovitis to be considered. After
proper preoperative checkup partial
synovectomy and biopsy done under
spinal anesthesia.
Medial para- patellar incision,
synovium was thickened with increase in
vascularity. Synovial fluid sent for culture
and sensitivity - the result after 72 hours
was sterile. Drain removed after 24
hours; collection was 50 ml only. Wound
inspection done on 3rd day which was
clean. Patient was discharged on 3rd
day. Suture removal was done after 14
days. Quadriceps exercises started from
second day onwards. The biopsy report
came after 2 weeks and it was a typical
March 2019 / FUTURE MEDICINE / 53