Surgical Treatment.—When the joint has become distended with fluid, as in the atrophic type of the disease, this should be removed by aspiration, after which firm strapping over Scott's dressing may be applied.
Various substances have been injected into the synovial cavity in the dry and hypertrophic forms of the disease, but the results have been generally unsatisfactory; cataphoresis will accomplish anything which such a method can accomplish, and no danger need be expected. Bue dinger injects a small quantity of sterilised liquefied Vaseline into the joint and states that by this trplan a freel range of motion can be obtained.
The breaking down of adhesions under chloroform anesthesia would appear to be clearly indicated in most cases where the crippling of the joint is complete, but this plan has given sometimes disastrous results. Owing to the erosion of cartilage in the advanced stage of the disease little movement can be expected to return after such a measure, and fracture of the bones is easily produced owing to their atrophic condition.
When the locking of an important joint can be demonstrated by the use of the X rays to be due to any osteophytic growth, it may be really necessary to open the articulation and remove the bone, whether this be loose or attached.
Excision of the affected joint is generally a futile procedure in advanced cases and an unnecessary one in the earlier stages of the disease, but it may become an imperative operation even in acute general cases when an articulation of primary importance like the jaw becomes hopelessly locked. It has been resorted to in acute cases with the view of eradicating the disease, but with disappointing results.
Deformities should be guarded against through the correction of faulty positions of the limb maintained during treatment; contractures are liable to occur necessitating tenotomy and section of muscles when a considerable range of movement still exists in the joint. Often such contractures can be straightened out by the application of a slowly extending force operating through a pulley and weight. In knee and hip cases the Thomas Splint may be advantageously employed sometimes, or a steel apparatus adjusted to a leathern pelvic girdle with hinge-joints opposite the knee, hip or ankle, which will permit of a range of motion short of producing acute pain.