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The best treatment is to excise the affected bursa, or, when this is impracticable, to lay it freely open, remove the tuberculous tissue with the sharp spoon or knife, and treat the cavity by the open method. Syphilitic disease is rarely recognised except in the form of bursal and peri-bursal gummata in front of the knee-joint.
In the tertiary stage the joint lesions are persistent and destructive, and result from the formation of gummata, either in the deeper layers of the synovial membrane or in the adjacent bone or periosteum. Peri-synovial and peri-bursal gummata are met with in relation to the knee-joint of middle-aged adults, especially women.
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