Aims. Tuberculosis (TB) is one of the biggest communicable causes of mortality worldwide. While incidence in the UK has continued to fall since 2011, Bradford retains one of the highest TB rates in the UK. This study aims to examine the local disease burden of musculoskeletal (MSK) TB, by analyzing common presenting factors within the famously diverse population of Bradford. Methods. An observational study was conducted, using data from the Bradford Teaching Hospitals TB database of patients with a formal diagnosis of MSK TB between January 2005 and July 2017. Patient data included demographic data (including nationality/date of entry to the UK), disease focus, microbiology, and management strategies. Disease incidence was calculated using population data from the Office for National Statistics. Poisson confidence intervals were calculated to demonstrate the extent of statistical error. Disease incidence and nationality were also analyzed, and correlation sought, using the chi-squared test. Results. Between January 2005 and July 2017, 109 cases of MSK TB were diagnosed in Bradford. Mean incidence was 1.65 per 100,000 population, per calendar year (SD 0.75). A total of 38 cases required surgical intervention. Low rates of antimicrobial resistance were encountered. A low rate of loss to follow-up was observed (four patients; 3.7%). Overall, 94.5% of patients (n = 103) were successfully treated. 67% of patients (n = 73) reported their country of origin as either India, Pakistan, or Bangladesh. These ethnicities account for around 25% of the local population. Conclusion. Bradford maintains a high prevalence of MSK TB infection relative to national data; the prevalence within the local immigrant population remains grossly disproportionate. Typical associated factors (HIV/hepatitis coinfection, drug resistance), have only modest prevalence in our dataset. However, local socioeconomic factors such as deprivation and poverty appear germane as suggested by global literature. We advocate a high degree of suspicion in treatment of atypical infection in any area with similar population factors to ensure timely diagnosis. Cite this article: Bone Jt Open 2022;3(5):432–440

Aims. Tuberculosis (TB) infection of bones and joints accounts for 6.7% of TB cases in England, and is associated with significant morbidity and disability. Public Health England reports that patients with TB experience delays in diagnosis and treatment. Our aims were to determine the demographics, presentation and investigation of patients with a TB infection of bones and joints, to help doctors assessing potential cases and to identify avoidable delays. Patients and Methods. This was a retrospective observational study of all adults with positive TB cultures on specimens taken at a tertiary orthopaedic centre between June 2012 and May 2014. A laboratory information system search identified the patients. The demographics, clinical presentation, radiology, histopathology and key clinical dates were obtained from medical records. Results. A total of 31 adult patients were identified. Their median age was 37 years (interquartile range (IQR): 29 to 53); 21 (68%) were male; 89% were migrants. The main sites affected were joints (10, 32%), the spine (8, 26%) and long bones (6, 19%); 8 (26%) had multifocal disease. The most common presenting symptoms were pain (29/31, 94%) and swelling (26/28, 93%). ‘Typical’ symptoms of TB, such as fever, sweats and weight loss, were uncommon. Patients waited a median of seven months (IQR 3 to 13.5) between the onset of symptoms and referral to the tertiary centre and 2.3 months (IQR 1.6 to 3.4.)) between referral and starting treatment. Radiology suggested TB in 26 (84%), but in seven patients (23%) the initial biopsy specimens were not sent for mycobacterial culture, necessitating a second biopsy. Rapid Polymerase Chain Reaction-based testing for TB using Xpert MTB/RIF was performed in five patients; 4 (80%) tested positive for TB. These patients had a reduced time between the diagnostic biopsy and starting treatment than those whose samples were not tested (median eight days versus 36 days, p = 0.016). Conclusion. Patients with bone and joint TB experience delays in diagnosis and treatment, some of which are avoidable. Maintaining a high index of clinical suspicion and sending specimens for mycobacterial culture are crucial to avoid missing cases. Rapid diagnostic tests reduce delays and should be performed on patients with radiological features of TB. Cite this article: Bone Joint J 2018;100-B:119–24

INTRODUCTION. Tuberculosis (TB) is a public health challenge. However, musculoskeletal involvement represents 10–15% of all extrapulmonary cases. Upper extremity involvement is extremely rare. The slow progressive course of clinical symptoms and lack of radiological signs lead to difficulties in establishing early diagnosis. Hence, the patients who have tuberculosis of the wrist are usually misdiagnosed. We report 5 cases of tuberculosis of the wrist seen in our unit from the year 2012 to 2021. METHODS. Cases were retrospectively evaluated on demographics, nature of history, clinical presentation, culture finding, and histopathological findings from 2012 to 2021 at our unit. RESULTS. A total of 5 cases were evaluated retrospectively. Three patients were more than 60 years old and two were less than 30 years old. Four of the patients presented with wrist swelling 2 of them had wrist pain and only 1 patient had discharge from the wound. The duration of the symptoms ranges from 2 months to 3 years. Only one of the patients had a history of pulmonary TB contact whereas the others didn't. All patients underwent surgery. All of the patients had positive cultures for Mycobacterium tuberculosis complex and histopathological examination showed necrotizing granulomatous inflammation from specimens taken intraoperatively, which confirmed the diagnosis of tuberculosis of the wrist. DISCUSSIONS. Our cases show that the common presentation of tuberculosis of the wrist was comparable to other literature. Most of the patients presented with chronic wrist swelling with or without wrist pain. The diagnosis of the disease was delayed an average of 10 - 12 months from symptoms onset to diagnosis. S. Bayram et al reported a case where the diagnosis was made 45 months later. Due to its rarity, it often is misdiagnosed, resulting in delays in the proper treatment. CONCLUSION. The diagnosis of the TB wrist remains difficult because of insidious and non-specific. presentation. However, early diagnosis is essential to avoid delays in treatment and complications. Hence, chronic wrist pain, and swelling with or without unexplained bone erosion around the wrist area must be highly suspected of being osteoarticular tuberculosis

Aim. Extraspinal osteoarticular tuberculosis (TOA-ER) is a rare form of extra-pulmonary tuberculosis. It remains a topical problem not only in underdeveloped countries but also in developed countries due to cases of immune deficiency. Through a study of 40 cases, we specify the current diagnostic aspects of TOA-ER and detail their therapeutic and evolutionary modalities. Method. The mean age of our patients was 40 years with a clear predominance of females observed (SR = 0.66). 76.31% of the cases were from a rural setting. The impairment was single-focal in 72.5%. Associated tuberculosis location was found in 59% of cases. Pain and swelling were the main clinical symptoms. Signs of tuberculous impregnation were found in less than half of the cases. The IDR was positive in 67%. All patients underwent an appropriate radiological exploration consisting of a standard x-ray (30 cases), CT (21 cases) and MRI (23 cases). technetium-99m bone scintigraphy, performed in 15 cases, detected 5 infra-clinical osteoarticular locations. 77.5% of patients had formal pathological and / or bacteriological confirmation of the diagnosis. All patients had adequate anti-tuberculosis chemotherapy with a mean duration of 18 months. 67% of patients had a surgical debridement procedure. Results. After a mean follow-up of 5 years, the outcome was favourable in 75.2% of cases. A microbiological cure at the cost of serious functional sequelae was noted in 12.8% of cases. The outcome was unfavourable with relapse observed in 4.8% of cases and death in 7.2% of cases. Conclusions. Extraspinal osteoarticular tuberculosis is a fairly common condition in our country. Its insidious clinical course is the cause of diagnostic and therapeutic delay. Its treatment is mainly medical. The surgery keeps some indications. Good therapeutic adherence and early diagnosis are the best guarantees of good therapeutic results

Aim. At our tertiary orthopaedic centre, mycobacterial cultures are routinely performed on bone and joint samples sent for bacterial culture. We have previously described the prevalence Mycobacterium tuberculosis Complex (MTBC) in these samples. Here, we describe the prevalence of non-tuberculous mycobacteria (NTM). We calculate the number needed to test to identify one previously undiagnosed mycobacterial bone or joint infection. Methods. Samples taken during a single procedure were pooled in one BACTEC MGIT culture. From laboratory records, we ascertained the number of mycobacterial cultures performed, the number positive for MTBC or NTM, and characteristics of individuals from whom mycobacteria were isolated. We collected the same data from 100 individuals with negative mycobacterial cultures. Results presented here are from interim analysis. Results. Excluding sample types that were clearly not bone or joint samples, 6162 mycobacterial cultures were performed between 4 July 2017 and 30 September 2022. Twenty-two patients had MTBC and 6 patients had NTM newly isolated from bone or joint samples placed in mycobacterial culture, with a further patient having both M. tuberculosis and M. avium isolated. In both patients with M. abscessus, the organism also grew in routine bacterial cultures. In one further patient, M. fortuitum was isolated from a sample not put into mycobacterial culture. To identify one new mycobacterial infection of bone or joint (MTBC or NTM) that would not be detected with routine bacterial cultures, 228 (95% CI 157 – 346) mycobacterial cultures were needed. The laboratory cost per additional patient identified using MGIT cultures was €12,540 (95% CI €8,635 - €19,030). Mycobacterial cultures were much less likely to be positive in samples taken from prosthetic joints. They were more likely to be positive in spinal samples and in samples taken from patients with suspected sarcoma. In patients for whom we had contemporaneous histological specimens, these demonstrated granulomatous inflammation in 86% (18/21) of patients from whom MTBC had been isolated but in neither of the two patients from whom only NTM was isolated. Ascertaining the clinical significance of NTM isolates is challenging, although in 2/8 cases the same organism was isolated following repeat sampling. Conclusions. Targeted rather than routine mycobacterial culture of bone and joint specimens should be considered in settings with a low burden of tuberculosis. NTM are rarely isolated from bone and joint specimens at our centre and fast growers may be isolated using routine bacterial culture

Bone localization of tuberculosis mainly affects the thoracolumbar spine. The cervical spine is rare. Its diagnosis is often late which exposes to great instability and potentially serious complications. We reported the case of a patient with cervical spine tuberculosis with a rare localisation. A 10-years old boy with no medical history, showed torticolis and high temperature without neurological complication. In the physical examination, he had torticolis and pain in the third, forth and fifth cervical vertebra. The biology showed high CRP 200mg/l. The tomodensitometry of the cervical spine showed a collection of the third cervical spine. The patient took non specific Antibiotics for two months with no radiological improvement. When biopsy was performed, we find an inter apophysis (between C3 and C4) collection. The histological examination confirmed the diagnosis of apophysis tuberculosis. The cervical spine is a rare localisation of the tuberculosis. The apophysis localisation is a more uncommon localisation. The diagnosis is difficult. The histological examination is essential for the diagnosis. The management based on tuberculosis chemotherapy and immobilization started as soon as possible

In the knee, involvement is mainly synovial, with local extension eroding the bone. Pure tuberculous osteitis is rare, with a few occasional reports. Patella tuberculosis is extremely rare. We report the case of patella tuberculosis with 7-years decline. A 10-years old boy suffered from knee siftness and pain. The patient had correct BCG vaccination. Clinical examination was relatively unrevealing, with tenderness on palpation of the medial joint surface of the patella, patellar crepitation, and slight effusion. On standard X-ray, the lateral view showed a circumferential rosette form with a light peripheral halo. The patient underwent open surgery with a medial parapatellar approach and arthrotomy. Joint fluid was sampled. Direct exploration of the medial side of the patella found soft but continuous cartilage on palpation. The histoligical examination confirmed the diagnosis of tuberculosis. The patient had 12 month anti-tuberculosis chemotherapy. After 7 years of the treatement, the patient had no recurrence and good clinical result. Bone tuberculosis remains difficult to diagnose. Certain locations should always be borne in mind, however rare, in case of pandemic or immunodeficiency. In case of osteolysis, associated with abscess or not, infectious etiology is to be considered and appropriate samples should be taken. Diagnosis is confirmed by histology and bacteriology. The slow evolution of bone tuberculosis requires local treatment of lesions and abscesses. Antibiotherapy regularly ensures recovery

A series of 14 patients suffering from tuberculosis of the sternum with a mean follow-up of 2.8 years (2 to 3.6) is presented. All were treated with antitubercular therapy: ten with primary therapy, two needed second-line therapy, and two required surgery (debridement). All showed complete healing and no evidence of recurrence at the last follow-up. MRI was useful in making the diagnosis at an early stage because atypical presentations resulting from HIV have become more common. Early adequate treatment with multidrug antitubercular therapy avoided the need for surgery in 12 of our 14 patients

There has been an increase in the incidence of bone and joint tuberculosis (BJTB) in The Netherlands and we have carried out an epidemiological study in order to find an explanation for this increase. Data from 1993 to 2000 from The Netherlands Tuberculosis Register (NTR) were used. In 1993 there was a total of 52 patients with BJTB. This figure increased gradually to 80 in 1999 before decreasing to 61 in 2000. There was a total of 12 447 patients with tuberculosis; BJTB was found in 532, accounting for 4.3% of all cases and 10.6% of all extrapulmonary cases. Localisation in the spine occurred in 56%. Certain immigrants, in particular from Somalia, were more likely to have BJTB than other immigrants or the native Dutch population. Increased age and female gender were associated with BJTB. Only 15% of BJTB patients also suffered from pulmonary tuberculosis. The usual long delay in the diagnosis of BJTB may be shortened if physicians are more aware of tuberculosis

Among the extra pulmonary forms of tuberculosis (TB), the osteoarticular localization has been detached in 1–2% of cases. In 30% of these children either a pulmonary and extra-pulmonary localization was found. The diagnosis of skeletal TB is often insidious due to variable signs and symptoms. The medical records of children admitted to our center between 2006 and 2013 due to skeletal TB were evaluated. All patient underwent TB skin test, IGRA test, chest X-ray and focused imaging tests. In the complicated forms of osteoarthritis the infected material drained spontaneously or surgically was analyzed for Mycobacterium Tuberculosis (MT) detection and culture. In patients with pulmonary localization gastric aspirates or sputum analysis was performed. Nine patients met the inclusion criteria. The median age at diagnosis was 7 (range 2–13) years. All patients presented with local osteoarticular symptoms and 4 of them had fever. In five cases there was a preceding history of minor trauma. Three patients had a case of TB in the family. Four patients had a spinal localization, three hips and two ankles. ERS and CRP values were altered in 7 and 4 patients respectively. All patient underwent radiography, bone three phase scintigraphy and a MRI. The diagnosis of tuberculosis was confirmed by histopathological examination of bone biopsy in 6 (66%) cases. The skin test and the IGRA test were positive in all patients. The chest X-ray showed a pulmonary localization in 3 cases that had positive gastric aspirate or sputum. All patients were treated with isoniazid, rifampicin pyrazinamide and ethambutol. In 3 patients Linezolid or Ciprofloxacin was also associated. The follow-up had an average value of 34 months. Sequelae were reported in 7 patients (limping in 5 cases, severe kyphosis in 2 cases). Owing to its low incidence in developed countries, the diagnosis ot TB is often delayed for months to years. Additionally, we highly recommend taking a biopsy of the site of suspected infection because an early diagnosis is the key to successful treatment

Purpose. The hip region is the second most common site for tuberculosis following the spine in children. The aim is to describe the variable radiological patterns of presentation and their resemblance to pyogenic infection, tumours and other benign conditions of bone in children. Methods. The clinical and radiological records of 29 children aged 10 months–13 years with confirmed tuberculosis of the hip region seen between 1990 and 2011 were reviewed retrospectively. Clinical features were pain, limp and flexion, adduction contractures. Abscesses and sinuses were seen in 4 children. The ESR ranged between 7–110 mm/hr. Mantoux was positive in 20 children. All cases were histologically confirmed. Treatment involved biopsy, currettage of bone defects, limited synovectomy and adductor tenotomy. Patients were immobilised for 4 weeks on a spica cast or traction. Antituberculous treatment was administered for 9–12 months. Results. Radiologically 9 lesions were extra-articular and 20 involved the joint synovium and articular surface. Extra-articular lesions were seen in the pubis, greater and lesser trochanter, ilium, proximal femur and peri-acetabular regions. Intra-articular lesions were seen in the femoral head, neck and acetabulum. Dislocations and subluxations occurred in 8 patients; various lesions mimicked pyogenic arthritis, idiopathic chondrolysis, chondrobastoma, Perthes disease, eosinophilic granuloma and osteoid osteoma. Follow up ranged between 8 months and 5 years. Good range of movement was seen in 20 children. Nine children had flexion adduction contractures, four of these had ankylosed hips and five required abduction extension osteotomies. Other changes seen were coxa vara (2) coxa magna (1) and avascular necrosis (3). Conclusion. The variable radiological picture of tuberculosis of the hip region can mimic various osteoarticular conditions in children. Biopsy is essential and should be taken from the bony lesion and not the synovium alone. NO DISCLOSURES

We report 79 cases of bone and joint tuberculosis between 1988 and 2005, eight of which were in the Caucasian population and 71 in the non-white population. The diagnosis was made in the majority (73.4%) by positive bacteriology and/or histology. The mean age at the time of diagnosis was higher in the Caucasian group at 51.5 years (28 to 66) than in the South Asian group at 36.85 years (12 to 93). Only one patient had previous BCG immunisation. The spine was the site most commonly affected (44.3%). Surgical stabilisation and/or decompression was performed in 23% of these cases because of cord compression on imaging or the presence of neurological signs. A six-month course of chemotherapy comprising of an initial two months of rifampicin, isoniazide, pyrazinamide and sometimes ethambutol followed by four months treatment with rifampicin and isoniazide, was successful in all cases without proven drug resistance

Subacromial corticosteroid injections are a well-recognised management for chronic shoulder pain and are routinely used in general practice and musculoskeletal clinics. Mycobacterium tuberculosis (TB) of a joint is a rare presentation in the United Kingdom. International literature exists for cases of reactivated latent tuberculosis following intra-articular corticosteroid injections in a knee; however there are no reports of a primary presentation of undiagnosed TB in a joint following therapeutic corticosteroid injections. A seventy-four year old lady presented with a one-year history of a painful shoulder, which clinically manifested as a rotator cuff tear with impingement syndrome. Following three subacromial depo-medrone injections, the patient developed a painless “cold” lump which was investigated as a suspicious, possibly metastatic lesion. This lump slowly developed a sinus and a subsequent MRI scan identified a large intra-articular abscess formation. The sinus then progressed to a large intra-articular 5×8 cm cavity with exposed bone (picture available). The patient had no diagnosis of TB but had pathogen exposure as a child via her parents. The patient underwent three weeks of multiple débridement and intravenous amoxicillin/flucloxacillin to treat Staphylococcus aureus grown on an initial culture. Despite best efforts the wound further dehisced with a very painful and immobile shoulder. Given the poor response to penicillin and ongoing wound breakdown there was a suspicion of TB. After a further fortnight, Mycobacterium tuberculosis was eventually cultured and quadruple antimicrobial therapy commenced. Ongoing débridement of the rotator cuff and bone was required alongside two months of unremitting closed vacuum dressing. The wound remained persistently open and excision of the humeral head was necessary, followed by secondary wound closure. There were no extra-articular manifestations of TB in this patient. At present the shoulder is de-functioned, the wound healed and shoulder pain free. This unique case study highlights that intra-articular corticosteroid can precipitate the first presentation of Mycobacterium tuberculosis septic arthritis. The evolution of symptoms mimic many other shoulder complaints making confident diagnosis a challenge. The infective bone and joint destruction did not respond to the management described in the current literature. There remains a further management issues as to whether arthroplasty surgery can be offered to post-TB infected shoulder joints. Taking a TB exposure history is indicated prior to local immunosuppressant injection, particularly in the older age group of western populations and ethnicities with known risk factors

Aim:. Historically, anterior decompression followed by posterior fusion has been the surgical management of choice in spinal tuberculosis. Due to theatre time being at a premium, we have evolved to performing anterior only debridement, allograft strut reconstruction and instrumentation for tuberculosis in the adult thoracic spine. The aim of this study is to review the safety and the efficacy of this treatment. Methods:. Twenty-eight adult thoracic tuberculosis patients were identified where anterior only surgery had been performed. These were all in the mid-thoracic spine as circumferential surgery is still favoured in thoracolumbar disease. The surgery was performed by a single surgeon at a tertiary hospital. Following transthoracic aggressive debridement, allograft humeral shafts were cut to size and inserted under compression and the spines instrumented with the use of screw-rod constructs into the body above and below. A retrospective review of clinical notes and radiological studies was performed. Results:. Twenty-seven of the patients presented with altered neurology; 2 had only sensory changes while 25 presented with paraparesis; 22 of these patients were unable to walk. The average surgical time was 2 hours 20 minutes with a median blood loss of 726 ml. The majority of patients had 2 vertebral bodies involved and required an average of a 4 body fusion. Surgical complications included inadvertent opening of the diaphragm in 1 patient and 1 patient deteriorated neurologically post operatively. 21 of 28 patients recovered to independent mobility at their latest follow-up appointment. 1 patient showed no recovery, 3 had some motor recovery that was not useful, 1 had some sensory but no motor recovery. 16 of 28 patients have documented bony fusion with no evidence of instrumentation failure in any patients. Conclusion:. Anterior only debridement, allograft strut reconstruction and instrumented fusion for the treatment of thoracic spinal tuberculosis is a safe and effective alternative to circumferential surgery in the adult patient

Aim. Skeletal tuberculosis (TB) accounts for up to one third of cases of extra-pulmonary TB but comprises a minority of osteoarticular infection in areas with low TB incidence. Consequently, unexpected cases may receive surgical management targeted at non-tuberculous orthopaedic infections. This study reviewed treatment and outcomes of non-spinal osteoarticular TB to assess outcomes from modern surgical techniques. Method. All patients with a diagnosis of non-spinal osteoarticular TB between 2009–2017 from one tertiary referral centre were included. Retrospective review of surgical intervention, antibiotic treatment and outcome was conducted. Results. Fourteen patients with an average age of 48 (range 20–77) were identified; all were HIV-negative. Articular infections affected 7 patients, including one prosthetic joint infection. Osteomyelitis affecting the carpus, femur, tibia, olecranon and metatarsals was diagnosed in the remaining patients. Only 4 patients had radiological findings consistent with prior pulmonary TB, and only 3 had a history of prior TB or TB exposure. In 2 cases, symptom exacerbation was associated with local steroid injection. Diagnostic biopsy was employed in 5 cases, of whom 4 proceeded to medical management. Diagnosis was made following positive culture in 86% of cases; all TB isolates were fully sensitive. 71% of cases underwent surgical treatment according to best practice for biofilm-forming infection, including excision of osteomyelitis with local antibiotic therapy for three patients, and first-stage excision with spacer implantation for four patients. Quadruple therapy for an average of 8.5 months, range 6–12 months, was administered. Patients were followed up for a mean of 15.2 months. Half of the patients treated with surgery reported ongoing pain at 3 months and 4 patients underwent further surgery for persistent signs of infection (2 for probable persistent TB, 2 for bacterial super-infection). Conclusions. The role of surgical debridement in management of osteoarticular TB is unclear. In patients with a previous history of TB exposure a pre-operative diagnosis of TB could prevent unnecessary surgery and therefore prevent associated post-operative complications including bacterial super-infection and pain. Pre-op biopsy should therefore be considered in all patients with a history of TB exposure

Aim

To evaluate efficacy of a one stage posterior approach in decompression and eradication of infection in TB spine.

In reverse shoulder arthroplasty (RSA), a high complication rate is noted in the international literature (24.7%), and limited local literature is available. The complications in our developing health system, with high HIV, tuberculosis and metabolic syndrome prevalence may be different from that in developed health systems where the literature largely emanates from. The aim of this study is to describe the complications and complication rate following RSA in a South African cohort. An analytical, cross-sectional study was done where all patients’ who received RSA over an 11 year period at a tertiary hospital were evaluated. One-hundred-and-twenty-six primary RSA patients met the inclusion criteria and a detailed retrospective evaluation of their demographics, clinical variables and complication associated with their shoulder arthroplasty were assessed. All fracture, revision and tumour resection arthroplasties were excluded, and a minimum of 6 months follow up was required. A primary RSA complication rate of 19.0% (24/126) was noted, with the most complications occurring after 90 days at 54.2% (13/24). Instability was the predominant delayed complication at 61.5% (8/13) and sepsis being the most common in the early days at 45.5% (5/11). Haematoma formation, hardware failure and axillary nerve injury were also noted at 4.2% each (1/24). Keeping in mind the immense difference in socioeconomical status and patient demographics in a third world country the RSA complication rate in this study correlates with the known international consensus. This also proves that RSA is still a suitable option for rotator cuff arthropathy and glenohumeral osteoarthritis even in an economically constrained environment like South Africa

Specific and rapid detection methods for spinal tuberculosis, with sufficient sensitivity in HIV-1 co-infected individuals, are needed, to ensure early initiation of appropriate treatment to prevent physical disability and neurological fallout. In addition, understanding the systemic and local pathophysiology of spinal tuberculosis, and its interaction with HIV-1 infection, is crucial to guide future therapeutic interventions. We prospectively enrolled adult patients presenting with signs and symptoms of suspected spinal tuberculosis, at Groote Schuur Hospital, between November 2020 and December 2021. TB diagnostic testing was performed on open and CT-guided spinal biopsies using Xpert MTB/RIF Ultra compared to gold standards TB culture and histology. A highly sensitive droplet digital PCR assay for detecting and quantifying Mycobacterium tuberculosis complex (MTBC) and HIV-1 DNA was tested. Plasma inflammatory proteins were measured to assess systemic inflammation. Xpert Ultra had a high sensitivity of 94.7% and specificity of 100% for STB against TB culture and histology in both open and CT-guided biopsy samples. The ddPCR assay confirmed TB detection in 94% of patients with positive Xpert Ultra results. Four patients with negative TB diagnostic results had MTBC DNA detected by ddPCR. HIV-1 DNA was detected in the spinal tissues from all HIV-1-infected patients. MTBC DNA levels were significantly higher in HIV-1-co-infected spinal tissue samples (p< 0.01). We identified four biomarkers significantly associated with higher bacterial burden at the disease site (p< 0.01). Xpert Ultra and MTBC ddPCR improve the detection of STB. DdPCR can be utilized as an additional, highly sensitive tool for detecting and quantifying Mtb, in pathological samples that may be paucibacillary. These findings provide novel diagnostic and pathophysiologic insight into STB, in the context of HIV-1 infection, and provide rationale to include these tests in hospital and research settings for patients from communities burdened by TB and HIV-1

Reverse Total shoulder arthroplasty (RTSA) was initially introduced to treat rotator cuff arthropathy. With proven successful long-term outcomes, it has gained a noteworthy surge in popularity with its indications consequently being extended to treating various traumatic glenohumeral diseases. Several countries holding national registries remain a guide to the use the prosthesis, however a notable lack of epidemiological data still exists. More so in South Africa where the spectrum of joint disease related to communicable diseases such as HIV and tuberculosis may influence indications and patient demographics. By analysing the epidemiology of patients who underwent RTSA at our institution, we aimed to outline the local disease spectrum, the patients afflicted and indications for surgery. A retrospective review of all patients operated within the sports unit between 1 January 2019 and 31 December 2022 was conducted. An analysis of the epidemiological data pertaining to patient demographics, diagnosis, indications for surgery and complications were recorded. Included in the review were 58 patients who underwent primary RTSA over the 4-year period. There were 41 females and 17 male patients, age <55 years (n= 14) >55 years (n=44). The indications included 23 rotator cuff arthropathy (40%), 12 primary glenohumeral osteoarthritis (OA) (20%), 10 avascular necrosis (AVN) humeral head (17%), 7 inflammatory OA (12%), 4 chronic shoulder dislocation (7%) and 2 sequalae of proximal humerus fractures (4%). The study revealed RTSA being performed in patients older than 55 years of age, the main pathologies included rotator cuff arthropathy and primary OA, however AVN and shoulder dislocations secondary to trauma contributed significantly to the total tally of surgeries undertaken. This highlights the disease burden of developing countries contributing to patients presenting for RTSA

When a suspicious spine lesion is identified, an accurate diagnosis based on tissue biopsy is needed to direct towards the correct treatment protocol. Several studies concluded that the percutaneous fluoroscopy guided biopsy of vertebral lesions is a safe, effective and accurate diagnostic tool and is preferred over open techniques when possible. The aim of this study was to review percutaneous fluoroscopy guided transpedicular spinal biopsies at a tertiary hospital over a 6-year period. The research design was a retrospective review of patients who underwent percutaneous transpedicular spinal biopsies under fluoroscopy guidance at a tertiary hospital over a six year period (1st January 2016 to the 31st December 2021). The spine theatre registry and hospital records system were used as the source for data collection. Statistical analysis was conducted to determine the effectiveness of transpedicular spinal biopsies, compare spinal pathology amongst age and gender and to identify any complications. The study analysed 180 biopsies, 120 yielding a positive result (66.67%). Of these 8.9% were pyogenic infection, 18.4% neoplasm, 36.7% Tuberculosis and 2.7% other. There were 75 males and 105 females with an age range between 9 and 86 years and mean age of 43.44. Comparing age and gender found no statistical significance (p = 0.778). Comparing biopsy result and gender showed no statistical significant relationship (p = 0.970). Comparison of biopsy result with age showed no statistical significant association (p = 0,545). Four complications were identified (2.22%). The study showed that fluoroscopy guided percutaneous transpedicular biopsy is an effective and safe modality in obtaining spinal specimens in all age groups for a wide spectrum of spinal pathological lesions