A 25-year-old woman with TB hip has a radiograph showing loss of joint space, osteoporosis, and peripheral osseous erosions but no central destruction or bony ankylosis. Which stage of TB hip does this represent, and what is the expected prognosis for the joint?

• A Stage II (early arthritis with erosions): good prognosis with anti-TB drugs; fibrous or bony ankylosis can occur
• B Stage I (synovitis stage): good prognosis, full recovery with anti-TB drugs likely ✓
• C Stage III (advanced arthritis with central destruction): poor prognosis; surgical reconstruction required
• D Stage IV (pathological dislocation): prognosis is hopeless without total hip replacement

Explanation

The described radiograph — joint-space narrowing, osteoporosis, and peripheral erosions (Phemister's triad without central destruction) — represents Stage I (synovitis/early arthritis). The triad includes: juxta-articular osteoporosis, peripheral osseous erosions, and gradual joint-space narrowing WITHOUT central destruction. At this stage, the articular cartilage is preserved centrally; anti-TB chemotherapy alone can achieve full recovery. Stage II shows true articular destruction; Stage III involves fibrous/bony ankylosis; Stage IV includes pathological dislocation.

Reference: Maheshwari Essential Orthopaedics, 6th ed.

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Written and medically reviewed by the StethoPrep medical team.