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March 1947

PROGRESS IN ORTHOPEDIC SURGERY FOR 1945 A Review Prepared by an Editorial Board of the American Academy of Orthopaedic SurgeonsVII. TUBERCULOSIS OF BONES AND JOINTS

Arch Surg. 1947;54(3):316-324. doi:10.1001/archsurg.1947.01230070322006

LEWIS156 expresses the opinion that Phemister's criteria, used in distinguishing tuberculous and nontuberculous (pyogenic or suppurative) arthritis, are of such importance as to warrant restatement.

In pyogenic (nontuberculous) arthritis, Phemister states that the articular cartilage is destroyed first at the points of contact and pressure and necrotic material is rapidly removed with the assistance of proteolytic ferments. However, the articular cartilage is not destroyed first in tuberculous arthritis but is protected at points of contact and pressure, the earliest destruction being peripheral, where tuberculous granulations can grow onto and remove the cartilage. The proteolytic ferments are not present as in pyogenic arthritis, so that masses of dead cartilage may persist for months or years. Also, the first evidence of destruction of bone is usually peripheral, where there has been absorption by the tuberculous granulations.

Thus, in terms of roentgenology, the joint space is narrowed early in pyogenic arthritis, while

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