In many cases, the appearance which the various parts of the diseased
joint present, are similar to those which have been already described
when treating of affections of the joints generally. Frequently,
however, the osseous tissue in this situation is much more extensively
affected. Often the whole cartilage on the head of the femur is
completely removed, exposing the bone in an ulcerated condition; and
when the system has long borne up under the disease, the greater
portion of the head, neck, and even of the trochanter, is destroyed,
the extremity of the bone being completely altered in form, and
composed of a loose and spongy structure. A similar disorganisation
occurs in the acetabulum; the mucous gland is destroyed, the cartilage
is often wholly removed, and the margins of the acetabulum absorbed,
a large and flat ulcerated depression merely being left for the
reception of the diseased femur; in other instances the margins
remain unaffected, whilst the ulceration proceeds in the centre, and
the cavity is thereby much deepened. Not unfrequently the ulceration
proceeds farther, and an aperture is formed in the acetabulum, so that
matter accumulates within the pelvis. The opening is sometimes so large
that the femur is protruded through it. When matter has formed in the
soft parts round the joint, portions of the bones of the pelvis, in
contact with the pus, are ulcerated to a greater or less extent, and
sometimes these ulcers are surrounded by deposits of new bony matter.
From such changes in the osseous parts of the articulation the limb
is shortened, sometimes to a great degree, though no dislocation has
occurred. Indeed, dislocation is by no means so frequent a cause of the
shortening as is generally believed.
If the head of the femur has been dislocated, and if the disease in
the joint has afterwards subsided, the acetabulum is found to be much
contracted, with its margins smooth and little elevated, and, if
the patient survive for a number of years, it will be almost wholly
obliterated. But a portion of the dorsum of the ilium, upward and
backward, which is the most frequent dislocation in this disease, is
gradually absorbed, so as to form a sort of glenoid cavity for the
reception of the femur, the extremity of which becomes more solid in
texture, and more smooth on its articular surface. The remaining neck
of the bone is in the sketch here given turned forwards, and must
have given rise to great eversion of the toes. I have seen one other
specimen of this form of luxation. The limb is generally, however,
inverted; and what remains of the head of the bone consequently points
backwards. The consecutive luxation occasionally, also, though rarely,
takes place upon the pubis. Whilst a depression is thus formed, new
bone is sometimes deposited round its margins, whereby the cavity is
increased in depth, so as to resemble somewhat the original acetabulum,
the new deposit having become smooth and of a regular form.
[Illustration]
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