The hip joint is the second most frequently affected joint from tuberculosis. It mostly affects children in developing countries, where tuberculosis is still common. The clinical presentation ranges from night cries to a severe painful limp, depending upon the stage of disease. The diagnosis is made on the basis of typical clinical features and radiological findings. MRI has become the gold standard investigation, often detecting disease early in the course before X-ray changes appear. If detected early, it can be treated conservatively. However, it’s not uncommon to see patients presenting late in the course of the natural history of disease which often leaves them crippled for life. The advent of total hip joint replacement is a ray of hope for such patients, allowing them to get back to a near-normal life.