THE TREATMENT OF BONE AND JOINT TUBERCULOSIS

¹ Clinic of the New York Orthopaedic Dispensary and Hospital, New York

Although experience with streptomycin and the hydrazides of isonicotinic acid is still too short to enable us to give any final opinion concerning their efficacy in the treatment of tuberculous bone and joint lesions, we believe that it is now safe to say that undoubtedly they exert a beneficial effect, an effect which is even striking in some active severe cases. The effect of these drugs also is striking in abscesses and sinuses. In the main, however, we believe that by themselves these drugs are not an adequate treatment and that they should be used as an adjunct to surgery. In our opinion, arthrodesis continues to be the safest and most effective method of treatment.

Examples have been cited of types of cases in which these drugs have resulted in apparent arrest of the disease with limited surgery and without arthrodesis. There is evidence that synovial tuberculosis of the knee may be treated successfully without surgery and that this treatment may also apply to tuberculosis of the tendon sheaths of the wrist and hand. Cautious experiments in this method of treatment should be continued.

It is important that in all cases thus treated the diagnosis should be proved beyond doubt either by aspiration and guinea pig inoculation or by biopsy. It also is essential to follow the patient for many years to make certain that there is not a reactivation of the disease.

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