COMBINED INTRA-ARTICULAR AND EXTRA-ARTICULAR ARTHRODESIS FOR TUBERCULOSIS OF THE HIP JOINT

¹ Section on Orthopaedic Surgery, The Mayo Clinic

Study of the end results in thirty-five cases discloses that bony fusion was secured in thirty-two (91.4 per cent.). The fact that there were no operative deaths indicates that among patients who are in good or fair general condition, a carefully conducted operation to produce arthrodesis in the hip should be advised without hesitation. From such a small series an opinion cannot be expressed as to its value for children, for there were only two patients in the first decade of life; union resulted in both cases, however. Although postoperative drainage due to dissemination of the tuberculosis to the contiguous soft parts is not a comfortable situation, and occurred in eleven of the cases, it was not as serious as might appear. Drainage followed in forty-four per cent. of cases in which there were "wet" joints and in twenty-two per cent. in which there were "dry" joints. It occurred in a higher percentage of cases when the operation was extra-articular than it did when the combined operation was employed. I interpret this to mean that the occurrence of drainage is less if the tuberculous tissue is cleanly removed, to the best of the surgeon's ability. A purely extra-articular operation is occasionally possible, but often tuberculous tissue is encountered. The percentage of "wet" joints in the combined intra-articular and extra-articular group and in the extra-articular group was the same.

The great improvement in the general health in these patients following arthrodesis has been most striking. A stiff hip has not been an added handicap, for the hip was not only stiff before operation but was painful. More uniformly successful results have been obtained by the combined method of intra-articular and extra-articular operation together with bone graft than by any other method.

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