End Results of Focal Débridement in Bone and Joint Tuberculosis and Its Indications

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Abstract
The use of antituberculous drugs in the treatment of bone and joint tuberculosis has had a definitely favorable effect. Although the maximum excellent effect of chemotherapy is not obtained when the drugs are combined with conservative (operative or non-operative) therapy, if they are combined with radical focal débridement, the results obtained are indeed remarkable. Focal débridement is a rational form of treatment without streptomycin, but in the treatment of lesions of the trunk it is absolutely necessary to combine it with streptomycin in order to reduce to a minimum the dangers of the operation. The end results of our study show statistical evidence that focal débridement combined with streptomycin, advocated by us about six years ago, is at present the best method of treatment. The superiority of this operation can be definitely proved after the operation by the rate of healing of sinuses or abscesses, by the course of the blood sedimentation rate, and by roentgenograms. In most of our cases in which focal débridement was done, firm bone ankylosis was the result after a period of one to two years. We are of the opinion that arthrodesis may better be performed secondarily, when needed, and that focal débridement should be done primarily. Our experimental studies reveal that, at this time, the effect of antituberculous chemotherapy upon bone and joint tuberculosis is still confined within certain limits. We are pessimistic about the possibilities of obtaining functional restoration of tuberculous joints by arthroplasty without any recurrence of the disease, and we believe that further improvements in chemotherapy must be made before such operations will be possible.

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