Septic Arthritis - Wheeless' Textbook of Orthopaedics

- See: orthopaedic infection menu

- Discussion:

- General Orders and Treatment
- synovial fluid exam;
- gram stain:
- gram negative bacilli:
- gram negative cocci: (NG)
- gram positive bacilli:
- gram positive bacilli
- ref: Gram staining in the diagnosis of acute septic arthritis.
- differential diagnosis
- lyme disease
- osteomyelitis
- radioisotope scanning
- Gallium scintigraphy for diagnosis of septic arthritis and osteomyelitis in children.

- Treatment Based on Age:
- less than 3 months
- upto 60-100% of neonates w/ septic arthritis have adjacent osteomyelitis.
- septic arthritis is both more common and more often associated w/ metaphyseal osteomyelitis in neonates than in older children;
- may occurs from transphyseal blood vessels (see epiphyseal vessels), which disappear by age
six months, and from synovial reflections over metaphyseal bone, which decrease with age;
- in the older children, only the metaphysis of the shoulder, hip, radial head and ankle remains intracapsular;
- from 6 mo to 2 yrs
- there should first be a search for evidence of other infections because a large percentage (50%) of children w/ hematogenous osteomyelitis and septic
arthritis have evidence of an associated infection;
- concomitant meningitis may occur in upto 20% of patients w/ septic arthritis due to H. influenzae;
- cerebrospinal examination should be considered and antibiotics that can cross the blood-brain barrier should be chosen;
- greater than 2 yrs
- references:
- Acute septic arthritis in infancy and childhood. 10 years' experience.
- Management of septic arthritis in children.
- Septic arthritis in children. Morrey BF, Bianco AJ, Rhodes KH: Orthop Clin North Am 1975;6:923.
- Septic arthritis in infants and children: A review of 117 cases. Pediatrics 1978; 92: 131. Nelson JD, Koontz WC:
- adults:
- staph aereus
- streptococcus
- adults with septic arthritis due to streptococcus should be worked up for multiple myeloma;
- neiseria 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:
- Septic arthritis in the elderly.

- Treatment Based on Location: (see open joint injuries)
- septic knee:
- septic hip:
- pediatric septic hip:
- adult hip:
- references:
- Sepsis of the hip in paraplegic patients.
- Hematogenous septic arthritis of the adult hip.
- SI Joint:
- references:
- Pyogenic arthritis of the sacro-iliac joint. Long-term follow-up.
- Disorders of the sacro-iliac joint in children.
- Pyogenic sacroiliitis in children.
- Aspiration of infected sarco-iliac joints.
- Pyogenic sacroiliac joint infection.
- Pyogenic arthritis of the SI joint in pediatric patients. UB Schaad et al. Pediatrics. Vol 66. 1980. p 375-379.
- The Early Diagnosis of Sacroiliac Joint Infections in Children.
                    - Septic Sacroiliitis in Children.

    - septic shoulder:
- in the study by CFA Bos et al 1999, 8 children (10 shoulders) were followed after shoulder sepsis;
- shoulders were treated with IV Atb, aspiration, and in two cases by arthrotomy;
- at follow up, 5 out of 10 shoulders had a full range of motion;
- one patient had shortening of 10 cm;
- functional loss was minimal in this series of patients;
- references:
- Percutaneous catheter drainage of septic shoulder joint.
- Pyogenic arthritis of the shoulder in adults.
- Septic arthritis of the shoulder in adults.
- Late sequelae of neonatal septic arthritis of the shoulder. CFA Bos et al. JBJS Vol 80-B. No 4. July 1998. p 645.
- Septic arthritis of the shoulder in children in Malawi. A randomised, prospective study of aspiration versus arthrotomy and washout.
                    - Septic arthritis of the glenohumeral joint. A report of 11 cases and review of the literature.
    - septic wrist:
- references:
- Septic arthritis of the wrist.
    - septic SC joint:
              - Sternoclavicular joint infection in hemodialysis patients. Nephron 1990;56:212-213.
              - Sternoclavicular osteomyelitis and pyoarthrosis as a complication of subclavian vein catheterization: Orthopedics 1984;7:1017-1021.
    - ankle joint:
              - Septic arthritis of the ankle joint
              - Hematogenous septic ankle arthritis.
              - Septic arthritis of the right ankle caused by Staphylococcus aureus infection in a rheumatoid arthritis patient treated with etanercept.
              - Fusion of the septic ankle: experience with 15 cases using hybrid external fixation

- Antibiotic Treatment Based on Organism:
- IV antibiotic menu
- Criteria for PO ATB's:
- references:
- Antibiotic concentrations in septic joint effusions. Nelson JD: N Engl J Med 1971;284:349.
- Etiology and medical management of acute suppurative bone and joint infections in pediatric patients. J Pediatr Orthop 1982; 2:313. Jackson MA, Nelson JD:
- 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.

- Surgical Drainage and Lavage:
- 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.

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