An 8-year-old boy has left hip pain and limping for 4 months. Radiographs show marked narrowing of the hip joint space, erosion of the articular margins of both the femoral head and acetabulum, and small cavities containing sequestra in the femoral head. There is no subluxation or dislocation. According to Tuli's staging of tuberculosis of the hip, this represents:

• A Stage I, synovitis
• B Stage III, advanced arthritis ✓
• C Stage II, early arthritis
• D Stage IV, advanced arthritis with subluxation or dislocation

Explanation

Tuli's staging: Stage I shows increased joint space and osteoporosis only; Stage II adds diminution of joint space with marginal erosions; Stage III shows marked joint space loss, articular surface erosion, cavities, sequestra, and destruction of the head or acetabulum without displacement; Stage IV adds subluxation or dislocation. Because this child has cavities and sequestra but no displacement, he is Stage III, not Stage IV.

Reference: Tuli's Textbook of Tuberculosis of the Skeletal System, 5th ed.

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Written and medically reviewed by the StethoPrep medical team.