The disease could turn out to be arrested or could go on to complete disorganisation; suppuration could ensue from infection by means of a breach of the surface, and in uncommon cases the joint has become the seat of tuberculosis. The additional progress is complicated by the incidence of pyogenic infection resulting in necrosis of bone, within the knee-joint, for example, the patella or one of the condyles of the femur or tibia, could furnish a sequestrum. Paris. On account of this uratic infiltration, the cartilage loses its vitality and crumbles away, leading to the formation of what are known as gouty ulcers, and these might prolong by the cartilage and invade the bone. If the bone is rarefied, the enlarged cancellous spaces are opened into and an eroded and worm-eaten look is led to; with further use of the joint, the bone is worn away, so that in a ball-and-socket joint like the hip, the top of the femur and the acetabulum are markedly altered in dimension and form. If the our bodies are so quite a few as to be tightly packed together, the impression is that of a plastic mass having the shape of the synovial sac.

Having mentioned this, I need to deal instantly and at some length with the query of violence. If the cartilages are sound, and if a movable joint is aimed toward, they may be left; but when ankylosis is desired, they must be removed. The knees are the joints most incessantly affected, and the situation usually yields readily to anti-syphilitic remedy with out impairment of perform. The joints of the decrease extremity are most commonly affected, and the illness is bilateral in a considerable proportion of instances–both knees or each hips, as an illustration, being implicated. The best possible outcome being inflexible ankylosis in a superb position, it could also be advisable to deliver this about artificially by arthrodesis or resection. It is often solitary, about the size of a bean or almond, concavo-convex in shape, the convex side being smooth like an articular floor, the concave side uneven and nodulated and exhibiting reparative modifications, healing over of the raw surface, and the new formation of fibrous tissue, hyaline cartilage and bone, the required nutriment being derived from the synovial fluid (Fig. 167). The physique is generally found to be lodged in a defect or excavation in one of the articular surfaces, normally the medial condyle of the femur, from which it is readily shelled out by the use of an elevator.

These degenerative and hypertrophic modifications, while usually attended with marked restriction of motion and sometimes by “locking” of the joint, practically by no means lead to ankylosis. On some particular motion, the body is disengaged, the locking disappears, and restoration takes place. In lots of cases a transparent account is given of the symptoms which arise when the physique is impacted between the articular surfaces, namely, sudden onset of intense sickening ache, lack of power in the limb and locking of the joint, followed by effusion and different accompaniments of a severe sprain. The disease may prolong to the synovial membrane and be attended with effusion into the joint, or it could erupt on the periosteal surface and invade the skin, forming a number of sinuses. They happen in tuberculosis, arthritis deformans, and in Charcot’s disease, and their presence is nearly invariably associated with an effusion of fluid into the joint.

As in tuberculosis, the illness may be first located within the synovial membrane, or it might unfold to the joint from one of the bones. The illness spreads all through the capsule and synovial membrane, which becomes diffusely thickened and infiltrated with granulation tissue which eats into and replaces the articular cartilage. Complete restoration is the rule, but when the muscles are weak and wasted from prolonged disuse, a considerable time may elapse earlier than the limb returns to regular. There isn’t a actual swelling of the joint, although there may be an look of this from losing of the muscles above and under. Because the swelling of the joint is related to losing of the muscles, with stiffness, and with flexion, the condition intently resembles tuberculous illness of the synovial membrane. Clinically, the condition resembles tuberculous disease of the synovial membrane, for which it might be continuously mistaken, but within the syphilitic affection the swelling is nodular and uneven, and the subjective symptoms are slight, mobility is little impaired, and but the deformity is considerable.