Quotation from: Manual of Surgery

Written by: Alexander Miles and Alexis Thomson


In many cases the extent of the operation can only be decided after
exploration. The aim is to remove all the disease with the least
impairment of function and the minimum sacrifice of healthy tissue. The
more open the method of operating the better, so that all parts of the
joint may be available for inspection. The methods of Kocher, which
permit of dislocating the joint, are specially to be recommended, as
this procedure affords the freest possible access. Diseased synovial
membrane is removed with the scissors or knife. If the cartilages are
sound, and if a movable joint is aimed at, they may be left; but if
ankylosis is desired, they must be removed. Localised disease of the
cartilage should be removed with the spoon or gouge, and the bone
beneath investigated. If the articular surface is extensively diseased,
a thin slice of bone should be removed, and if foci in the marrow are
then revealed, it is better to gouge them out than to remove further
slices of bone, as this involves sacrifice of the cortex and periosteum.

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