septic arthritis

2.  A joint inflammation due to an infection usually involving
the synovial joints
 50% cases - children less than 5 years
 30% cases - children less than 2 years
 Most dangerous and destructive monoarthritis
 Can destroy cartilage within days
 Mortality 7-15 % despite antibiotic use

4.  Knee – 53%
 Hip – 20%
 Elbow – 17%
 Shoulder – 10%

5.  Knee – 39%
 Hip – 32%

6.  Can be bacterial, fungal, mycobacterial or viral
 Bacterial divided into
gonococcal –more common less morbid
nongonococcal
Staphylococcus
Hemophilus influenza
Streptococcus
E. coli
Proteus

10.  RA
 SLE
 Immosupressive therapy or disorders
 DM
 Chronic debilitating disorders – CLD, RF

11.  Previous joint trauma
 h/o arthritis to same joint
 Degenerative joint disease
 Gout/ pseudogout

13.  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.

14.  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 joint.

16.  Fever
 Pain
 Pseudo paresis

17.  Neonates
 FEW CLININCAL SIGNS
 May not be febrile
 Loss of spontaneous movement of extremity
 Hip- flexion, abduction, eternally rotated

18.  In children
 Local signs of inflammation
 Rapid pulse and SWINGING FEVER
 All joint movements - RESTRICTED

19.  In adults
Often a superficial joint – knee, ankle, wrist
Joint is painful, swollen, inflamed
Restriction of movements

20. 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 comfort):
Hip: abducted, flexed and externally rotated.
Knee, ankle and elbow: partially flexed.
Shoulder: abducted and internally rotated

21.  Routine blood investigations
 Xray
 USG
 Diagnostic aspiration
 MRI

22.  Leucocytosis >12,000.
 ESR>40 mm/hr.
 CRP- elevated.
 Blood culture-may be positive.

23.  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 joint.

28.  Can be used to detect even the smallest amount of joint effusion.
 Non invasive, inexpensive and easy to use.
 Can be used to guide joint aspiration.

30.  In early cases- fluid may be clear.
 Sample sent for Gram staining, microscopy,
culture, and antibiotic sensitivity.
 Normal synovial fluid leucocyte count: under
300/ml.
 Leucocyte count>50,000 per ml with 90%
PMN strongly suggestive of septic arthritis.

32. STREPTOCOCCUS

33. H. INFLUENZA

35.  Can detect infection and extent of infection.
 Useful in diagnosing infections that are difficult
to access.
 Also useful in differentiating between bone and
soft tissue infections and in detecting joint
effusion.

37.  Acute osteomyelitis.
 Trauma
 Irritable joint
 Hemophilic joint.
 Rheumatic fever
 Gout and pseudogout
 Gaucher’s disease.

38.  IV fluids- to prevent dehydration.
 Analgesics- for pain.
 Joint must be rested either on splint or in a widely split plaster.

39.  Broad spectrum IV antibiotics are started immediately and then depending on
microbiological investigations, specific antimicrobial therapy is started.

40.  Duration of treatment: IV antibiotics given for minimum of 2 weeks.
 Oral antibiotics:
Children-2-4 weeks.
Adults- 4-6 weeks.

41. 1-Joints that do not respond to antimicrobial therapy and daily arthrocentesis
2-.Any joint with limited accessibility, including the sternoclavicular or the hip joint
3-Patients with underlying disease, including diabetes, rheumatoid arthritis,
immunosuppression, or others systemic symptoms, should be treated more
aggressively with earlier surgical intervention

42.  In septic arthritis of hip- surgical drainage is always done.
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 days.

43.  In knee- arthroscopic debridement and copious irrigation.
In adults- repeated closed aspiration of joint may be done.
But if no improvement within 48 hours- open drainage is necessary.

44.  Joint Destruction
 Coxa magna
 Pathological Dislocation
 Acute Osteomyelitis
 Septicemia
 Secondary osteoarthritis
 Avascular necrosis

45.  Non gonococcal bacterial arthritis is a dangerous and destructive form of acute
arthritis
 Risk factors include pre-existing joint disease, joint replacement, old age,
immunosuppression and overlying infection or ulceration
 It usually presents as monoarthritis involving a large joint like the knee
 Because symptoms such as fever may be absent and tests such as FBC and CRP are
non specific, joint aspiration is necessary to establish the diagnosis- for cell count,
microscopy and culture. BC are also useful
 Staph and strep are the most common pathogens and are usually treated with
flucloxicillin, but older patients, ICU patients, IVDUs may have gram-ves and
given3rd gen cephalosporin
 Joint drainage- by needle aspiration or surgical means should also be considered