We describe a case concerning tuberculous coxitis 55 years after primary tuberculosis. A 76-year old man developed hip pain, weight loss and a gluteal tumor. After three months he was diagnosed with tuberculous coxitis by ultrasound assisted aspiration from the joint. Anti-tuberculous chemotherapy was commenced. After three months a Girdlestone operation was performed and seven months later a total hip replacement was performed. Anti-tuberculous chemotherapy was continued for a total of 12 months. Early ultrasound assisted aspiration from the joint is recommended to shorten diagnostic delay and optimise treatment of tuberculous coxitis.