Sacroiliac joint tuberculosis

Infections of the sacroiliac joint are uncommon and the diagnosis is usually delayed. In a retrospective study, 17 patients who had been treated for tuberculosis sacroiliitis between 1994 and 2004 were reviewed. Two patients were excluded due to a short follow-up (less than 2 years). Low back pain and difficulty in walking were the most common presenting features. Two patients presented with a buttock abscess and spondylitis of the lumbar spine was noted in two patients. The Gaenslen’s and FABER (flexion, abduction and external rotation) tests were positive in all patients. Radiological changes included loss of cortical margins with erosion of the joints. An open biopsy and curettage was performed in all patients; histology revealed chronic infection and acid-fast bacilli were isolated in nine patients. Antituberculous (TB) medication was administered for 18 months and the follow-up ranged from 3 to 10 years (mean: 5 years). The sacroiliac joint fused spontaneously within 2 years. Although all patients had mild discomfort in the lower back following treatment they had no difficulty in walking. Sacroiliac joint infection must be included in the differential diagnosis of lower back pain and meticulous history and clinical evaluation of the joint are essential

Osteonecrosis of the Talus

Osteonecrosis of the talus (ONT) refers to the death of osteocytes and subsequent structural changes leading to talus collapse and secondary ankle joint osteoarthritis. ONT is a rarer disease than osteonecrosis of the femoral head (ONFH); however it is a signifi cant clinical challenge with an uncertain long-term prognosis [ 1, 2 ]. In this chapter, we review osteonecrosis of the talus, describing incidence and etiology, blood supply, clinical presentation, diagnostic imaging, classifi cation, and treatment.N