Premature epiphysial fusion at the knee joint in tuberculous disease of the hip.

The treatment of tuberculous disease of the hip in children has not yet reached the stage when useful recovery of joint function is a frequent end-result. Brackett (1924) urged that the first objective should be the provision of a permanently safe and useful limb; and in girls, we would add, a graceful one. These standards are not achieved, even with quiescent disease and a soundly ankylosed joint, if there has been arrest of limb growth at an early age. As long ago as 1899 Sir Robert Jones estimated the frequency of this complication to be in the region of 15 per cent. ; but it was not until 1944 that Gill showed that it was caused by premature epiphysial fusion at the knee joint and drew further attention to the severity of the disability. This review was undertaken to determine the present incidence of premature epiphysial fusion in children who had been treated for tuberculous disease of the hip by prolonged conservative measures ; and to study the relationship of this complication to the disease, the changes which precede and accompany premature fusion, and the possibilities of earlier recognition and prevention. The patients were treated at four hospitals in the Liverpool area : Alder Hey Children’s Hospital ; Liverpool Open-Air Hospital ; Royal Liverpool Children’s Hospital; and Wrightington Hospital. The study included all patients with tuberculous disease of the hip joint who were in-patients of these hospitals during 1947, except those in whom the disease first began after the age of fifteen years. There were ninety-one diseased hips in ninety patients-forty-two right, forty-nine left ; forty-seven male, forty-four female ; with a duration of disease varying from four months to twenty-two years. In addition to general study of the clinical and radiographic findings the examination included individual mensuration of the long bones, and X-ray films of both hips, both knees, and both ankles.