American practice of surgery : a complete system of the science and art of surgery . s pressure, if too long continued, not only in-creases the impairment of the joint structures, butalso, through interference with the function oflarge and important articulations, materially hinders constitutional improve-ment, which in turn exerts a decided influence upon the affected joints. Thearthrotomy is generally performed through two lateral incisions which runparallel with the femur and are equidistant (about 3 or 4 cm.) from the sidesof the patella, the lower third of the incision being directly over
American practice of surgery : a complete system of the science and art of surgery . s pressure, if too long continued, not only in-creases the impairment of the joint structures, butalso, through interference with the function oflarge and important articulations, materially hinders constitutional improve-ment, which in turn exerts a decided influence upon the affected joints. Thearthrotomy is generally performed through two lateral incisions which runparallel with the femur and are equidistant (about 3 or 4 cm.) from the sidesof the patella, the lower third of the incision being directly over the line ofthe joint. After the joint has been opened the larger fringes are dissected offwith scissors and the joint is washed out with sterile water. The synovialcapsule is closed with interrupted silk, and the skin with silkworm gut. Drain-age is generally not necessary. If flexion of the joint has existed previous tothe operation it is generally better to put the joint up in a plaster-of-Paris dress-ing in the corrected position. Passive motion and release from permanent re-. Fig. 22fi.—The Bradford-Gold-thwait < ienuclast Applied. NON-TUBERCULOUS INFLAMMATIONS OF JOINTS. 513 straint should begin when the stitches are removed, at the end of the first cicatrization of the bases of the fringes prevents further swelling of thejoint from villous changes, and so great is the power of repair in endothelialtissue that new synovial membrane is very quickly made to grow over thebases of the excised villi. Because of this rapid repair adhesions rarely followarthrotomy for this purpose. There is little hemorrhage from these excisedfringes. Prognosis.—Contrary to the usual opinion the outlook for patients with thisdisease is not bad if the condition is recognized early and proper treatment iscommenced. The patients must be made to recognize the importance of theiractive co-operation in the management of the case, and relief from care andresponsibility, or whatever the
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