Acta Medica 14. (1959)

1959 / 1. szám - Riskó, T.: The Significance of Radiological Changes in the Knee Joint in Tuberculous Coxitis in Childhood

THE SIGNIFICANCE OF RADIOLOGICAL CHANGES IN THE KNEE JOINT IN TUBERCULOUS COXITIS IN CHILDHOOD By T. Kiskó •‘FODOR JÓZSEF” STATE TUBERCULOSIS INSTITUTE (Received June 23, 1958) The tuberculosis of bones ami joints, as it occurs in childhood, presents many radiological problems. The growing cartilaginous epiphysis of the child makes the response of the bone to tuberculosis different from what we see in adults. Moreover, in the tuberculous coxitis of the child we find interesting and significant radiological changes not only in the affected bones, but also in adjacent ones, first of all in those forming the knee joint. These knee joint changes require attention for two reasons. First, it is common knowledge that tuberculous coxitis of the child often presents with pain referred to the knee joint, presumably as a result of the irritation of the obturator nerve [1]. In this phase bilateral X-rays of the knees show a slight atrophy in the affected joint, apparently due to disuse and toxic effects. The other reason warranting attention must be discussed in more detail. It is commonly known from the reports by Gill (1944), Kestler (1947) and Ross (1948) that in adults the affected limb is often considerably shortened if the tuberculous coxitis had developed in childhood, but was diagnosed in adult age. Destruction of the hip joint (including the cartilaginous epiphysis) by tuberculosis is not the sole cause of this shortening. It has been shown recently that the lesion chiefly responsible for it is a premature destruction and ossification of the cartilaginous epiphysis in the knee joint, resulting from a lack of physiological weight bearing. This change means at the same time a cessation of bone growth in that area. As the legs grow mainly from the direction of the knee joint, the leg as a whole will be considerably shorter. This happened in one of our cases (W. B., No. 755—1954). The girl, now 14 years of age, had been treated for tuberculous coxitis since the age of 6 years. Her affected left hip joint had been immobilized in plaster casts for 18 months and subsequently she had been wearing leg splints and orthopaedic shoes for 2 years. This treatment had failed to arrest the hip joint affection and the left leg had continued to shorten. On admission to our Institute the left leg was 17 cm shorter than the right one, the motions of the left hip were restricted and the left knee was painless. An X-ray of the knees (the lirst ever made, because she had no complaints about her knees) 1 Acta Medica XIV/l.