OBJECTIVE: To investigate the feasibility of first-stage joint replacement for active-stage joint tuberculosis. Clinical data: 16 cases of active joint tuberculosis, 9 males and 7 females; age 18-55 years, average 30.8 years. There were 11 cases in the hip joint and 5 cases in the knee joint. Case inclusion criteria: primary treatment of joint tuberculosis; pus in the joint, or cold abscess around the joint; bone destruction and bone marrow edema. Exclusion criteria: old joint tuberculosis; stationary joint tuberculosis. Preoperative preparation: anti-TB treatment for 2-4 weeks, anti-TB is effective; blood sedimentation and CRP are decreasing; correction of anemia Surgical details: 1. Prosthesis selection: general common prosthesis can be completed without special prosthesis; choose non-cemented prosthesis; 2. Treatment of lesion: thorough removal of necrotic tissue and pus, flushing strong repeated flushing, flushing solution: rifampin flushing solution, isoniazid flushing solution, streptomycin flushing solution; 3. Bone Treatment of defects: femoral neck or cancellous bone of femur, soaked with streptomycin solution, high pressure rinsing with rinse gun, and compression bone grafting. Generally, acetabular bone defects are more common, and sometimes there are large ramus bone defects. Post-operative management: the grounding was slightly late, usually after 4 weeks, and the abduction was abandoned in 3 months. Postoperatively, chemotherapy was administered for 1-1.5 years according to drug sensitivity test and blood sedimentation. Results: follow-up time 3-20 months, mean 8 months. Wound healing: 2 cases developed sinus tracts. The rest of the wounds healed in one stage, and the healing time was not different from that of normal joint replacement surgery. No recurrence of tuberculosis was observed during the follow-up period. Function: One case had limited functional activity of the knee joint, while the rest had good joint mobility. Discussion: 1. selection of surgical indications; 2. selection of surgical timing; 3. focus of current controversy. CONCLUSION: For active stage joint tuberculosis, with effective anti-TB, one-stage joint replacement can be performed.