Oral health plays a vital role in overall well-being and is Tuberculosis remains a global health challenge, with millions of new cases annually. While pulmonary TB is the most common presentation, the disease can spread to other body systems, causing extrapulmonary complications. Skeletal TB, including spinal deformities and joint involvement, arises when Mycobacterium tuberculosis infects bone or joint tissues. These complications, if untreated, can lead to severe morbidity and permanent disability. This study focuses on understanding the prevalence of orthopaedic complications in patients with TB chest and the effectiveness of current management strategies.

Study Design: This study utilized a retrospective observational design to analyze data from patient records at a tertiary care hospital.

Sample Size: The study included 200 patients diagnosed with pulmonary TB over a five-year period (2018-2023). Patients were selected based on inclusion and exclusion criteria.

• Inclusion Criteria: Patients with confirmed pulmonary TB and documented orthopaedic complications (e.g., spinal deformities, joint involvement).
• Exclusion Criteria: Patients with non-TB-related orthopaedic issues or incomplete medical records.

Sampling Method: Purposive sampling was used to ensure representation of cases with documented orthopaedic complications. The hospital’s electronic medical records system was queried using diagnostic codes related to TB and skeletal disorders.

Data Collection: Data were extracted from medical records using a structured data extraction form. Key variables included:

• Patient demographics (age, gender, socio-economic status)
• Clinical presentation (symptoms, duration of illness)
• Diagnostic methods (X-rays, MRI, laboratory tests like ESR and GeneXpert)
• Treatment details (anti-tubercular therapy regimen, surgical interventions, physiotherapy protocols)
• Outcomes (functional improvement, recurrence, complications)

Data Validation: Data were cross-verified by two independent reviewers to ensure accuracy and completeness.

Statistical Analysis: Data were analyzed using SPSS software (version 26). Descriptive statistics were used to summarize the data, including means and standard deviations for continuous variables and frequencies and percentages for categorical variables. Inferential statistics included:

• Chi-square Test: To examine associations between categorical variables.
• Paired t-test: To compare pre- and post-treatment outcomes.
• One-way ANOVA: To assess differences in outcomes across management strategies.

1. Frequency of Orthopaedic Complications:
• Spinal involvement (Pott's disease): 25% (n=50)
• Joint involvement (tuberculous arthritis): 15% (n=30)
• Other skeletal manifestations: 10% (n=20)
2. Risk Factors:
• Delayed diagnosis of pulmonary TB
• Poor adherence to anti-tubercular therapy (ATT)
• Malnutrition and immunosuppression
3. Statistical Analysis of Data:

1. Management Outcomes:

The prevalence of orthopaedic complications in TB chest patients underscores the systemic nature of the disease. Spinal deformities and joint involvement are common due to the hematogenous spread of Mycobacterium tuberculosis. Early diagnosis through imaging (X-rays, MRI) and laboratory tests (ESR, CRP, GeneXpert) is critical for preventing severe disability.

These findings align with other studies that have reported similar prevalence rates of orthopaedic complications in TB patients. Jain et al. (2015) [3] documented a 23% incidence of spinal TB in a cohort of pulmonary TB patients, closely matching the 25% observed in this study. Similarly, Tuli et al. (2012) [2] emphasized the importance of early diagnosis and ATT adherence in minimizing skeletal complications. This study’s surgical intervention success rate (75%) slightly exceeds the 68% reported in Rao et al. (2020) [4], reflecting advancements in surgical techniques and postoperative care.

In contrast, Chakravorty et al. (2018) [5] observed lower physiotherapy outcomes (mean improvement score of approximately 70) compared to this study (80.1 ± 6.9), likely due to differences in rehabilitation protocols. A study by Smith et al. (2017) [6] found a similar association between structured rehabilitation programs and improved patient outcomes.

Comparatively, Murlidhar et al. (2019) [7] found spinal TB in 28% of cases, a slightly higher prevalence than the present study. The management approach in their cohort, which included fewer surgical interventions, resulted in lower success rates. Zhang et al. (2016) [8] demonstrated the effectiveness of early ATT combined with surgery, achieving outcomes comparable to the present findings. Lee et al. (2021) [9] and Gupta et al. (2014) [10] further corroborated the necessity of a multidisciplinary approach to optimize treatment efficacy.

This study highlights the importance of integrated medical, surgical, and rehabilitative care for managing orthopaedic complications of TB chest. Future research should explore standardized protocols and assess long-term outcomes.

Limitations While this study provides valuable insights into the frequency and management of orthopaedic complications in TB chest patients, it has certain limitations:

1. Retrospective Design: The study relies on existing medical records, which may have incomplete or inconsistent documentation.
2. Single-Center Analysis: Findings are based on data from a single tertiary care hospital, limiting generalizability to other settings or regions.
3. Sample Size: Although 200 cases were analyzed, a larger, more diverse sample could provide more robust conclusions.
4. Lack of Longitudinal Data: The study does not track long-term outcomes of patients post-treatment, which could offer insights into recurrence rates and sustained improvements.
5. Limited Diagnostic Comparisons: Advanced diagnostic methods, such as PET-CT, were not uniformly applied, potentially affecting the detection of complications.
6. Sociocultural Factors: The study does not account for sociocultural or economic factors that might influence treatment adherence and outcomes.

Despite these limitations, the findings serve as a foundation for future multicenter, prospective studies with larger sample sizes and standardized protocols.

The prevalence of orthopaedic complications in TB chest patients underscores the systemic nature of the disease. Spinal deformities and joint involvement are common due to the hematogenous spread of Mycobacterium tuberculosis. Early diagnosis through imaging (X-rays, MRI) and laboratory tests (ESR, CRP, GeneXpert) is critical for preventing severe disability.

Orthopaedic complications of TB chest are a significant health burden, requiring a multidisciplinary approach for effective management. Public health efforts should focus on early detection, adherence to ATT, and comprehensive care, including surgery and rehabilitation, to reduce morbidity and improve patient outcomes. Further research is needed to develop optimized protocols for managing these complications.

1. WHO Global Tuberculosis Report 2021
2. Tuli SM. "Tuberculosis of the Skeletal System." Jaypee Brothers Medical Publishers.
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4. Rao KS et al. "Management of Spinal Tuberculosis: Current Perspectives." International Journal of Spine Surgery.
5. Chakravorty A et al. "Tuberculous Arthritis: Clinical Features and Treatment Outcomes." Journal of Clinical Rheumatology.
6. Smith R et al. "Rehabilitation Protocols in Skeletal TB." Physiotherapy Journal.
7. Murlidhar R et al. "Skeletal TB in Rural India." Journal of Rural Medicine.
8. Zhang Y et al. "Comparative Study of ATT and Surgical Interventions in TB Patients." Journal of Orthopaedic Research.
9. Lee H et al. "Advancements in Spinal TB Management." Spine Surgery Journal.
10. Gupta S et al. "Multidisciplinary Approaches to TB Complications." International Journal of Tuberculosis and Lung Disease.