Tuberculosis (TB) of the musculoskeletal system remains a significant public health challenge, especially in developing countries. Despite being an ancient disease, it continues to present diagnostic and therapeutic difficulties due to its insidious onset, diverse manifestations, and overlapping features with other pathologies. This chapter provides an in-depth overview of bone and joint tuberculosis, encompassing historical perspectives, pathogenesis, clinical presentation, diagnostic modalities, and current management protocols. The disease primarily affects the spine, hip, and knee joints, with rare involvement of small bones, flat bones, and atypical sites such as the shoulder, elbow, and foot. Advances in imaging, microbiological diagnostics, and anti-tubercular therapy (ATT) have revolutionized treatment, allowing for high cure rates and functional recovery in most cases. However, delayed diagnosis, drug resistance, and immunosuppression continue to pose challenges. This chapter also explores regional variants of osteoarticular TB, the impact of HIV co-infection, and the indications for surgical intervention. Emphasis is placed on early recognition, prolonged multidrug therapy, and the judicious use of surgery to prevent long-term deformity and disability.