The chemotherapy regimen for osteoarticular tuberculosis is an effective drug regimen based on the pathological characteristics of osteoarticular tuberculosis, the ecological characteristics of Mycobacterium tuberculosis and anti-tuberculosis drugs and their pharmacokinetics, combined with previous clinical chemotherapy practice and literature. For the conservative treatment of osteoarticular tuberculosis of the extremities and spinal tuberculosis, we still use a long course chemotherapy regimen with a full course of 18 months; for surgically treated spinal tuberculosis, a short course chemotherapy regimen with a full course of 8 months can be used. In recent years, there are reports of irregular short-course regimens, and after the intensive phase, the consolidation period can be extended according to the needs of the disease, such as changing the 4HRZE/2HRE regimen to 4HRZE/XHRE, where (X~2) is the number of months of extension. the WHO advocates the supervised management of tuberculosis chemotherapy throughout the course (DOTS) is also the key to the success of chemotherapy plus surgery for osteoarticular tuberculosis. MDR-TB treatment principles: individualized treatment plan based on previous drug history, drug sensitivity test or according to experts, or treatment plan can be developed with reference to the Chinese Anti-TB Association’s “Opinions on the Treatment of Multidrug Resistant Tuberculosis”. In clinical practice, it is not uncommon for surgery to be performed without considering the surgical indications, resulting in surgical failure. Improper timing of surgery is an important cause of surgical failure, deterioration of disease, and spread of tuberculosis. The choice of surgical timing is the key to success or failure of surgery. In the initial stage of Mycobacterium tuberculosis infection, the tissue around the lesion is congested and edematous, with a large amount of exudation, proliferation of Mycobacterium tuberculosis, and a high rate of positive culture of Mycobacterium tuberculosis. Patients have different degrees of pain, fever, weakness, night sweats, etc. At this time, surgery bleeds a lot, which can easily cause the spread of lesions and non-healing wounds. Research proves that most patients with abscesses no longer increase in size, pain decreases, appetite increases and spirit improves in 6~8 weeks of medication, suggesting that the immunity of the body and the effect of medication are sufficient to control the development of the disease, and the surgical effect is better at this time. The patient’s symptoms, signs, medication time, blood sedimentation, C-reactive protein and X-ray performance can be used as indicators to observe the regression of the lesion. In addition, surgical treatment cannot be implemented immediately even if there is an indication for surgery, but should also depend on the presence of contraindications to surgery. Those without contraindications should also consider when the patient has the ability to withstand surgical trauma, the least possibility of accidental unpredictability, and when the lesion is cleared most completely and is less likely to cause lesion recurrence. This requires choosing the appropriate timing of surgery to ensure that the maximum effect occurs and the adverse consequences are minimized. Many literatures believe that lesion removal is feasible only when the blood sedimentation and C-reactive protein return to normal or near normal after the application of regular and systematic anti-tuberculosis treatment. We observed that the sedimentation and C-reactive protein did not decrease before surgery in many patients, and they tended to increase during the anti-tuberculosis period and in the short term after surgery, and the sedimentation and C-reactive protein gradually decreased to normal only 2 months after surgery and 1 month after surgery. Generally speaking, patients with bone and joint tuberculosis have a long history of disease and poor health, and the pus cavity formed is large, and it is difficult for anti-tuberculosis drugs to enter the joint cavity, which causes the blood sedimentation not to drop; patients with tuberculosis often have anemia and hypoproteinemia, which is also a reason for the fast increase of blood sedimentation. Therefore, only early removal of the lesion, reduction of toxin absorption, supplementation of whole blood and serum protein, combined with effective anti-tuberculosis drug treatment, can normalize the hematocrit and C-reactive protein. Blood sedimentation cannot be used as an indicator to choose the timing of surgery, but only as an indicator to evaluate the regression of tuberculosis. Blood sedimentation and C-reactive protein increase and then decrease after the clearance of bone and joint tuberculosis lesions, and C-reactive protein is more sensitive than blood sedimentation. Seeking effective laboratory indicators to evaluate the timing of surgery for osteoarthritic tuberculosis and the outcome of treatment is one of the future research directions.