Tuberculosis of the hip is the second most frequent form of skeletal tuberculosis in the body. It can involve the femoral head, neck and proximal shaft of the femur and the acetabulum of the hip joint. It presents much like other joints, being divided into several stages, following haematogenous spread from a primary foci.

Firstly the joint goes through a stage of synovitis, where the synovial membrane that lines the joint becomes inflamed. The patient will usually have pain, especially when moving, and swelling due to synovial fluid collecting in the joint; they may also develop a limp with apparent lengthening of the limb. This is followed by arthritis where the cartilage in the joint becomes damaged and muscle spasms may be in evidence along with apparent shortening of the limb. Finally the joint goes through a process of erosion, where the cartilage is totally destroyed and the bone is affected anywhere from minor eburnation to full destruction of the femoral head and/or acetabulum. Dislocation of the hip is possible along with true shortening of the limb.

Radiographic features during the arthritis and erosion stages of disease are considered to be very obvious and diagnostic. These can include soft tissue swelling, localised osteoporosis, reduction in the joint space and the destruction of the joint with possible dislocation. These changes can be seen clearly through the radiographs of Stannington patient 141/1946, an 11 year old girl with tuberculosis of the left hip. The x-ray report for this patient is as follows and corresponds with the images respective of date:

23/10/42 - Lt hip: marked decalcification both femur and acetabulum, no erosion of head of femur.

15/11/43 - Hip: more decalcification and destruction - femur tending to dislocate.

27/7/45 - Hip: Head of acetabulum partly destroyed some rarefied - joint space destroyed - calcium content of bone improved.

13/8/46 - Hip: radiographic appearance ISQ [in status quo]

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