Groulier P, Curvale G, Franceschi J P, Bataille J F
Service de Chirurgie Orthopédique et Traumatologique, Hôpital de la Conception, Marseille.
Rev Chir Orthop Reparatrice Appar Mot. 1995;81(4):344-8.
The authors report two cases of tuberculosis of the greater trochanter as an uncommon localization in osseous tuberculosis.
1st case: A 77 year old male presented with hip pain and swelling. Laboratory studies revealed an increased erythrocyte sedimentation rate. The patient had a positive skin test reaction for tuberculosis. Radiographs showed greater trochanter remodeling. M.R.I. demonstrated a bilobed abscess. There were enough arguments to initiate medical treatment, before surgery: excision of the abscess and partial trochanteric resection. 2nd case: In a 51 year old male, a large lytic lesion of the whole greater trochanter suggesting benign bone tumors was found an radiographs after a traumatism. Curettage and grafting were undertaken. The final diagnosis was made with the results of the intra-operative samples culture of and led to appropriate medical treatment.
The outcome was good in both cases with four years follow-up for the first case, and two years for the second one.
Trochanteritis Tuberculosis occurs in 1.8 per cent of bony tuberculosis cases. Local symptoms are discrete and the diagnosis is belatedly made when the tuberculous abscess appears. Radiographs and CT scan show the bony lesions: unevenness of the contours of the trochanter and several gaps in it. MRI shows the abscess and its spread. The microbiological test (when antibiotic therapy has not been initiated) and anatomo-pathological tests confirm the diagnosis. General treatment is based on a six month long specific antibiotic therapy. Local treatment concerns the abscess and the bony lesions. As the case may be; careful curettage is undertaken, or wide excision is performed.
