Synovectomy and curettage in the treatment of tuberculosis of joints.

(;irdlestolle (1940) wrote that “ dotting his time in the wards of a London hospital, first as a student and then as a house surgeon, Potts disease and hip disease had meant deformity, septic complications and the slow miserable process of lardaceous disease. In contrast to tilis, the work of Sir Robert Jones in open-air hospitals in Shropshire and Hes vall seemt’d miraculous. The children with hips, spines and knees looked perfectly well. ‘ ‘ l’hese wor(ls illustrate a principle which is as true to-day as when they were written. Tiley paint a picturt’ of ‘ ‘ old, unhappy, far-off things and battles long ago. ‘ ‘ With the advantages that antihiotio’s offer to the modern surgeon it is important that the old teaching should not he forgotten. The results described in this paper would not have been possible except in an open-air country hospital where constitutional treatment is carried out carefully. The value of constitutional treatment alone, though great, was limited. Prolo)ngt’(l sphntage was necessary which, in the child, stunted physical development ; miliar ’ tuberculosis and meningitis or septic complications migilt develop. Even after healing of the disease, a major operation might he required to stabilise the joint and function was lost. ‘l’here was a substantial late mortality from associated tuberculous lesions. For example, Harris anti Coulthard (1942) followed up 296 patients treated for skeletal tuberculosis for periods varying from one to ten years and found that eighty-five had died. Approximately half of these deaths were from miliary dissemination or sepsis, and most others from associated ttli)erctllous lesions. The main problems therefore, before the introduction of antibiotics, wert’ to reduce the mortality from sepsis, miliarv tuberculosis and associated lesions, and to save joint function. The introduction of antibiotics might have been expected to reduce the incidence’ O)f sepsis and miliarv tuberculosis, and this, in fact, is what has happened at Black Notley, in spite of the adoption of open operations into tuherculous joints \vhicil are to i)e described. The effect of antibiotics on associated lesions has yet to be assessed but its effect appears too