 A joint inflammation due to an
infection usually involving synovial
 50% of cases- children less than 5
 30% of cases- children less than 2
8. Predisposing factors- Local
Previous joint trauma.
H/o arthritis to the same joint.
Degenerative joint disease.
Crystal induced joint disease.(gout
 Bacteria rapidly gains access to the joint cavity and
settles in the synovial membrane.
 Acute inflammatory reaction occurs with formation
of serous or seropurulent exudate.
 Articular cartilage is eroded and destroyed due to
the action of bacterial toxins and by enzymes
released from the synovium and inflammatory cells.
 In late cases- extensive erosion due to synovial
proliferation and ingrowth.
10.  If untreated- spread to the underlying bone or burst
out of the joint to form abscesses and sinuses.
 With healing:
1. Complete resolution.
2. Partial loss of cartilage and fibrosis of joint.
3. Loss of articular cartilage and bony ankylosis.
4. Bone destruction and permanent deformity of the
11. Clinical Features- Symptoms
 Pain over joint.
 Reluctance to move joint(pseudoparesis).
 In neonates:
Few clinical signs.
Child may not have fever.
Loss of spontaneous movement of extremity.
Hip-flexion, abduction, and external rotation.
13.  In children: signs of local inflammation are present.
 Rapid pulse and swinging fever.
 Overlying skin-red.
 Swelling may be present.
 Local rise of temperature and marked tenderness
 All movements of joint- restricted.
14.  In adults:
Often a superficial joint( knee, wrist or ankle).
Joint is painful, swollen, and inflamed.
Movements are restricted.
15. PHYSICAL EXAMINATION
1. Decreased or absent range of motion.
2. Signs of inflammation: joint swelling, warmth,
tenderness and erythema.
3. Joint orientation as to minimize pain (position of
 Hip: abducted, flexed and externally rotated.
 Knee, ankle and elbow: partially flexed.
 Shoulder: abducted and internally rotated
In early stages- usually normal.
Later on- joint space widening
may be present and subluxation
of the joint may be present.
In late stages- irregularity of the
19. Septic arthritis
of the ankle
 Can be used to detect even the smallest
amount of joint effusion.
 Non invasive, inexpensive and easy to
 Can be used to guide joint aspiration.
21. JOINT ASPIRATION
 In early cases- fluid may be clear.
 Sample sent for Gram staining, microscopy, culture,
and antibiotic sensitivity.
 Normal synovial fluid leucocyte count: under
 Leucocyte count>50,000 per ml with 90% PMN-
strongly suggestive of septic arthritis.
23. H. influenzae
 Can detect infection and extent of infection.
 Useful in diagnosing infections that are difficult to
 Also useful in differentiating between bone and soft
tissue infections and in detecting joint effusion.
 IV fluids- to prevent dehydration.
 Analgesics- for pain.
 Joint must be rested either on splint or in a widely
 Broad spectrum IV antibiotics are started
immediately and then depending on microbiological
investigations, specific antimicrobial therapy is
 First line antibiotics: Benzyl penicillin, flucloxacillin,
 Second line antibiotics: Vancomycin, Clindamycin,
Fusidin, and Teicoplanin.
 Hemophilus infection- cephalosporins.
28.  Duration of treatment: IV antibiotics given for
minimum of 2 weeks.
 Oral antibiotics:
Adults- 4-6 weeks.
Indication of Surgical Drainage:
1-Joints that do not respond to antimicrobial therapy and daily
2-. Any joint with limited accessibility, including the sternoclavicular
or the hip joint
3-Patients with underlying disease, including diabetes, rheumatoid
arthritis, immunosuppression, or other systemic symptoms, should
be treated more aggressively with earlier surgical intervention
 In septic arthritis of hip- surgical drainage is always
 Best approach-anterolateral
 Joint is opened through a small incision and washed
with normal saline.
 Small drain is left in place after incision is closed.
 Suction-irrigation is continued for another 2 or 3
31.  In knee- arthroscopic debridement and copious
 In adults- repeated closed aspiration of joint may
 But if no improvement within 48 hours- open
drainage is necessary.
34.  Septic arthritis of the hip.
 Seen in infants.
 Head of femur is completely destroyed by the
35.  Transphyseal vessels are present in early infancy
before the formation of the growth plate This may
account for the frequency of septic arthritis of the
hip in the neonate
 In children, about a third of long-bone
osteomyelitis is associated with septic arthritis of the
36. Clinical features
 Onset is acute with rapid abscess formation.
 Can be mistaken for a superfical infection.
 Can present later with complaints of limp without
 O/E: Affected leg is shorter and hip movements are
increased in all directions.
 Telescopy test-positive.
37.  X-ray- complete absence of the head and neck of
 Condition resembles DDH; complete absence of
head and neck and normally developed round
 Acute surgical emergency.
 Open drainage of hip joint is the most effective
method of treatment in septic arthritis of the hip.
 Arthroscopic drainage can also be attempted.