Duke Orthopaedics
Wheeless' Textbook of Orthopaedics

Septic Arthritis

- Discussion
    - orthopaedic infection menu 
    - general orders and treatment 
    - differential diagnosis  (also consder Brucella melitensis, Borrelia burgdorferi and Treponema pallidum)
             - Painful knee--an unusual cause secondary to pseudomonas septic arthritis of the hip.
             - Septic until proven otherwise: approach to and treatment of the septic joint in adult patients.
             - Indicators for detection of septic arthritis in the acutely swollen joint cohort of those without joint prostheses.

    - medical considerations:
             - consider the need for a cardiac echo (eval for endocarditis), labs for immunosuppression (HIV, Hep B)
    - synovial fluid exam; (cell count and crystals)
             - gram stain: (gram negative bacilli, gram negative cocci: (NG), gram positive bacilli:, gram positive bacilli)
             - references:
                   - Gram staining in the diagnosis of acute septic arthritis.
                   - How sensitive is the synovial fluid white blood cell count in diagnosing septic arthritis?
                   - Does the presence of crystal arthritis rule out septic arthritis?

- Treatment Based on Age: - less than 3 months, from 6 mo to 2 yrs, greater than 2 yrs 

- Treatment Based on Location: (open joint injuries, septic knee:, pediatric septic hip:) 

- Antibiotic Treatment Based on Organism:

        - IV antibiotic menu (criteria for PO ATBs)
        - Anaerobic Joint Infections
        - Niseria gonococcus
                - most common organism causing septic arthritis in young adults;
                - look for skin lesions;
                - unlike most forms of septic arthritis, GC does not necessarily require surgical washout, and and usually responds
                         to IV antibiotics alone. 
        - references:
                - Antibiotic concentrations in septic joint effusions.  
                - Etiology and medical management of acute suppurative bone and joint infections in peds patients
                - Benefits and risks of sequential parenteral--oral cephalosporin therapy for suppurative bone and joint infections.
                - The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis.
                - Septic arthritis in the elderly
                - Staphylococcal septic arthritis: antibiotic and nonsteroidal anti-inflammatory drug treatment in a rabbit model.
                - Experimental septic arthritis in rabbits treated by a combination of antibiotic and steroid drugs.
                - Dexamethasone Therapy for Septic Arthritis in Children: Results of a Randomized Double-blind Placebo-controlled Study

 - Surgical Drainage and Lavage:
    - consider vancomycin in calcium sulfate carrier.
    - references:
            - Lavage of septic joints in rabbits: effects of chondrolysis.
            - Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint.
            - Results of treatment of septic knee arthritis: a retrospective series of 40 cases.
            - Arthroscopic drainage in septic arthritides of the knee: a multicenter study.
            - Arthroscopic treatment of septic joints: prognostic factors.
            - Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy.
            - Arthroscopic management of septic arthritis: stages of infection and results.
            - Arthroscopic therapy of septic arthritis. Surgical technique and results
            - Septic arthritis: Arthroscopic management with local antibiotic treatment.
            - Septic arthritis: current diagnostic and therapeutic algorithm.
            - Management of septic arthritis: a systematic review.
            - Tidal irrigation in septic arthritis of the knee: a potential alternative to surgical drainage.
            - Treatment of septic knee arthritis: comparison of arthroscopic debridement alone or combined with continuous closed irrigation-suction system.
            - Percutaneous aspiration irrigation drainage technique in the management of septic arthritis in children.

- Controversies: use of steroids with septic arthritis:
     - Acute Septic Arthritis
       - Dexamethasone Added to Antibiotics Improved Clinical and Laboratory Outcomes in Children with Septic Arthritis
       - Osteomyelitis and septic arthritis in children: current concepts
       - Dexamethasone therapy for septic arthritis in children: results of a randomized double-blind placebo-controlled study.
       - Intra-articular corticosteroids in septic arthritis: beneficial or barmy?
       - Experimental septic arthritis in rabbits treated by a combination of antibiotic and steroid drugs.


Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, January 7, 2015 10:30 am

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