Again we have ample proof of our former statement that joint tuberculosis is essentially a disease of childhood and of early adult life. Table VI shows that 211, or 68 per cent., of our 310 patients were in the first three decades of life at the time of admission to the hospital. The highest mortality was in the third decade. We are still convinced that the disease is very serious and that the mortality is high.
Operative surgery is utilized in some instances, where possible, to eliminate by amputation a joint which cannot be salvaged or, more frequently, to put a joint completely at rest by fusion. In neither instance does surgery alone effect the cure. It may turn the tide in favor of the patient.
As we have shown, the patient's ultimate fate depends largely upon the type and extent of his infection with tuberculosis. The mortality of 48.2 per cent. among those patients in Groups C and D and 9.5 per cent. in those in Groups A and B should speak for itself.
The reduction in mortality from 47 per cent. in our former report to 33 per cent. in patients with tubercle bacilli in their sputum—that is, active pulmonary disease on entering the hospital—is a highly encouraging evidence of what collapse therapy for the lungs and surgery for the involved joint can accomplish.
The patient with the metastatic spread of the disease still presents a formidable barrier to brilliant statistical results. In the light of our experience, it must be considered foolhardy to attempt other than emergency surgery on those patients with evident metastatic spread.
The majority of the deaths in the more favorable groups are due to prolonged suppuration. Many of these, we feel, can be prevented by earlier operative intervention. The end results in this type of surgery are, for the most part, not brilliant. Of the 330 joints treated surgically, there were excellent results in 55.1 per cent., uncertain results in 18.8 per cent., and death occurred in 26.1 per cent. (See Table VII.) This work is definitely salvage, and we are glad to be able to restore to their homes and to such activities as they may resume over 50 per cent. of these patients. It is to be hoped that, with increasing knowledge of tuberculosis, the incidence of all forms of this disease will continue to decline sharply and that such surgery as is necessary may be done early, before the patient becomes dangerously ill.