BACTERIA IN THE BONE



The relief on Nanda Patil's face is easy to spot. Although a walker stands next to her at all times, it's not a symbol of assistance. It's affirmation that Patil can walk. It's the first time in eight years that the Kolhapur resident has been able to walk. In 2007, Patil, now 58, first experienced pain in her left knee. Over the years, the soreness worsened, leaving her unable to stand on her feet. When treatment with local doctors led nowhere, desperate, Patil's husband Shivaji sought help from a quack, who he claims slammed a brick into her knee to induce movement. "Last year, a relative suggested that I consult specialists in Mumbai," says Patil.
Experts at a well-known hospital diagnosed her with osteoarthritis of the knee, recommending knee replacement surgery. Within 15 days of the procedure that cost the Patils over Rs 1 lakh, she noticed pus forming in the joint. The stitches were infected. "The doctor said it was normal," she recalls. This is how it stayed for two months, before she was taken back to hospital where doctors opened up the wound, removed the joint, cleaned the area and reset it. The joint had to be cleared of pus every hour, and the pain had made it impossible to walk.

TESTING FOR TB

In October 2014, Patil consulted the doctors again. "This time, they sent the pus to the lab and tests confirmed the presence of tuberculosis bacilli," says Shivaji. Patil underwent a third surgery where doctors removed the metal knee implant, since chances of the infection spreading were high, and replaced it with medicated cement to control it. Patil's woes were far from over. Because of this procedure, she was unable to move the joint. The pus was continuing to develop and in the six months that doctors had been treating her clumsily, the bacteria had eaten into the bone too. Bedridden, Patil looked worse than she did six months ago.

IN THE OT, AGAIN

Dr Pradip Bhosale, director of the orthopaedic department at Nanavati Hospital, says, when the Patils consulted him in January 2015, Patil was incapacitated. "She had been unable to bend her knee for almost a year. There was persistent draining of fluid from the surgical wound and it was clear from the very first X-ray that hers was not a case of osteoarthritis but bone TB," says Bhosale, explaining that had it been osteoarthritis, both joints would have been affected. Instead of immediately working on the joint, Bhosale prescribed an anti-TB course for four months prior to surgery. "Once the infection was under control, I conducted a complex Revision Total knee replacement surgery with bone grafts, using specially anti-TB medicated bone cement. I conducted a surgical release of all tight tissue structures around the joint and reconstructed them so that Patil's knee could bear weight once again," he says. This time, Patil was able to bend her knee within two days of the operation. "Not all cases need to undergo knee replacement. If the infection is detected before the damage is done, the joint can be easily saved," Bhosale clarifies.

TROUBLE IN THE JOINT

Tuberculosis is a bacterial infection that can spread through the lymph nodes and bloodstream to any part of your body. While it most often affects the lungs, it can attack bones and joints too. Dr Bhosale says the reason bone TB goes undetected for long is that the symptoms start appearing only 10 years after the initial infection. While pulmonary TB (lung) can spread through the air, bone TB is not contagious unless you come in contact with a patient's pus. TB of the bone doesn't show classic symptoms such as weight loss or fever, making diagnosis difficult. A good pointer is if you are suffering from extra swelling or pain in only one joint. To distinguish it from arthritic pain, patients should observe the nature of the pain. "Most patients of arthritis experience relief at night when lying down. For those suffering from bone TB, lying flat increases discomfort due to increased bacterial activity," he adds. Additionally, no damage to the cartilage will be evident in the X-ray — a first sign of osteoarthritis.
Source - ahmedabad mirror
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