Tuberculosis of the femoral neck and greater trochanter.

During the nine years up to the end of 1956 six cases of tuberculosis of the femoral neck have been treated at Heatherwood Orthopaedic Hospital. This relatively uncommon lesion has formed less than 05 per cent of all the skeletal tuberculosis treated. Many authors have regarded tuberculosis of the femoral neck as the primary site of bone involvement in tuberculosis of the hip joint, and have included it in reviews of that lesion. This is not surprising because, in the absence of chemotherapy, most of these lesions have extended into the hip joint to cause a pan-arthritis irrespective of the method of treatment. Bergman (1930) described a good result in a single case with a juxta-epiphysial lesion treated conservatively. He also quoted four cases of Waldenstrom’s with satisfactory results two years after treatment by excision. Logroscino (1936) gave a useful classification of lesions of the femoral neck. He divided these on a regional basis into four types of focus : 1) cervicodiaphysial; 2) juxta-epiphysial; 3) bulbo-metaphysial; 4) metaphysial subtrochanteric. He claimed good results in six of fifteen patients treated conservatively and stated that a pan-arthritis followed excision. Hatcher and Phemister (1937), in a review of tuberculosis of the hip joint in seventy children, stated that the juxta-epiphysial region of the femoral neck was the commonest site of primary bone involvement and was affected in fourteen children. The hip joint remained intact in only two of these patients. Cholmeley (1939) reported fifty-five patients with extra-articular lesions. The disease spread to involve the hip in eleven out of twelve patients treated surgically and forty out of forty-three treated conservatively. Ponseti (1948) referred to seven out of thirty-one patients with para-articular foci. Four were in the ilium and three in the femoral neck. The disease spread to involve the hip in all seven patients irrespective of the method of treatment. Dobson (1951), in a review of 320 cases of tuberculosis of the hip, stated that primary bone involvement of the femoral neck occurred in only fifteen patients. Wilkinson (1953) stated that a tuberculous infection of the ends of long bones was usually accompanied by involvement of the synovial membrane. He claimed satisfactory results in nineteen of twentythree patients treated by curettage and partial synovectomy under antibiotic cover.