The terminations vary with the gravity of the infection and with the stage at which treatment is instituted.  In the milder forms recovery is the rule, with more or less complete restoration of function.  In more severe forms the joint may be permanently damaged as a result of fibrous or bony ankylosis, or from displacement or dislocation.  From changes in the peri-articular structures there may be contracture in an undesirable position, and in young subjects the growth of the limb may be interfered with.  The persistence of sinuses is usually due to disease in one or other of the adjacent bones.  In the most severe forms, and especially when several joints are involved, death may result from toxaemia.

The treatment is carried out on the same principles as in other pyogenic infections.  The limb is immobilised in such an attitude that should stiffness occur there will be the least interference with function.  Extension by weight and pulley is the most valuable means of allaying muscular spasm and relieving intra-articular tension and of counteracting the tendency to flexion; as much as 15 or 20 pounds may be required to relieve the pain.

The induction of hyperaemia is sometimes remarkably efficacious in relieving pain and in arresting the progress of the infection.  If the fluid in the joint is in sufficient quantity to cause tension, if it persists, or if there is reason to suspect that it is purulent, it should be withdrawn without delay; an exploring syringe usually suffices, the skin being punctured with a tenotomy knife, and, as practised by Murphy, 5 to 15 c.c. of a 2 per cent. solution of formalin in glycerin are injected and the wound is closed.  In virulent infections the injection may be repeated in twenty-four hours.  Drainage by tube or otherwise is to be condemned (Murphy).  A vaccine may be prepared from the fluid in the joint and injected into the subcutaneous cellular tissue.

Suppuration in the peri-articular soft parts or in one of the adjacent bones must be looked for and dealt with.

When convalescence is established, attention is directed to the restoration of the functions of the limb, and to the prevention of stiffness and deformity by movements and massage, and the use of hot-air and other baths.

At a later stage, and especially in neglected cases, operative and other measures may be required for deformity or ankylosis.

#Metastatic Forms of Pyogenic Infection#

In #pyaemia#, one or more joints may fill with pus without marked symptoms or signs, and if the pus is aspirated without delay the joint often recovers without impairment of function.

In #typhoid fever#, joint lesions result from infection with the typhoid bacillus alone or along with pyogenic organisms, and run their course with or without suppuration; there is again a remarkable absence of symptoms, and attention may only be called to the condition by the occurrence of dislocation.