the presentation includes basic information of septic arthritis and gives an idea about its general management, microorganism causing it, and general symptoms. The information is categorically placed into different subtitles.

1. SEPTIC ARTHRITIS
Dr. Sumeet Jadhav
JR2/Dr. S. K. S. Unit
Department of Orthopaedics

2. INTRODUCTION
• Pathological joint space invasion
by microbes followed by
inflammation
OR
• Inflammation of synovial
membrane due to infection
which results in purulent
effusion in joint capsule

3. ETIOLOGY
HEMATOGENOUS
(MOST COMMON)
SECONDARY TO
NEARBY
OSTEOMYELITIS
PENETRATING
WOUND
IATROGENIC
E.g. INTRARTICULAR
STEROID INJECTION OR
FEMORAL BLOOD
COLLECTION
Ogranism can gain
entry into joint by any
of the following route

4. SPREAD OF INFECTION TO JOINT CAPSULE
INFLAMMATORY REACTION WITH SEROPURULENT EXUDATE
INCREASE IN SYNOVIAL FLUID
ARTICULAR CARTILAGE IS ERODED AND
DESTROYED

6. CAUSATIVE MICROORGANISM
STAPH. AUREUS (MC)
NEONATES AND YOUNGER INFANTS GROUP B STREPTOCOCCI AND GRAM NEGATIVE
ENTERIC BACILLI
SEXUALLY ACTIVE ADOLESCENTS AND ADULTS N. GONORRHOEA
IV DRUG ABUSER, IMMUNOCOMPRAMISED GRAM NEGATIVE BACILLI LIKE E. COLI AND
PSEUDOMONAS
SICKLE CELL ANEMIA SALMONELLA
PROSTHETIC JOINT RECEIPIENTS CoNS E. g. STAPH EPIDERMIS
POLYARTICULAR STAPHYLOCOCCUS > STREPTOCOCCI GROUP G
OTHER M. TUBERCULOSIS

7. CAUSATIVE MICROORGANISM
• VIRAL: HEPATITIS A,B,C
HERPES VIRUS
MUMPS
• FUNGAL: CISTOPLASMA
COCCIDIODES
BLASTOMYCOSIS

8. CLINICAL FEATURES
INFANT
FEATURES OF SEPTICEMIA ARE MORE AS
COMPARED TO JOINT PAIN
JOINT IS WARMTH, RESISTANT TO
MOVEMENT, TENDERNESS
CHILDREN
MONOARTICULAR
REDNESS AND SUPERFICIAL JOINT
SWELLING VISIBLE
LOCAL WARMTH AND TENDERNESS
RESTRICTION OF MOVEMENTS

9. CLINICAL FEATURES
ADULTS
• JOINT IS PAINFUL, SWOLLEN AND INFLAMED
• DECREASED ABILITY TO MOVE THE JOINT
• SYSTEMIC SYMPTOMS LIKE FEVER WITH CHILLS,
MALAISE, POOR APPETITE, IRRITABILITY
• SUPERFICIAL JOINTS ARE AFFECTED MORE

10. DIAGNOSTIC TRIAD
PAINFUL
JOINT
LIMITATION
ELEVATED ESR
HIGH GRADE
FEVER WITH
RIGOR

11. KOCHER’S CRITERIA
VARIABLE INCLUDES
1. NON WEIGHT BEARING ON AFFECTED SIDE
2. ERYTHROCYTE SEDIMENTATION RATE > 40
3. FEVER > 38.5 C
4. WHITE BLOOD CELL COUNT > 12000
SCORE LIKELIHOOD OF SEPTIC ARTHRITIS
1 3 %
2 40 %
3 93 %
4 99%

12. TOM SMITH ARTHRITIS
• SEPTIC ARTHRITIS OF HIP IN INFANCY
• HEAD OF FEMUR IS RAPIDLY DESTROYED BY PYOGENIC PROCESS.
• CAUSE:
- METAPHYSIS IS INTRASYNOVIAL
- PRESENCE OF TRANSEPIPHYSEAL VESSEL IN CHILDREN TILL THE AGE OF 18 MONTHS
• PATHOPHYSIOOGY
- INCREASED INTRAARTIULAR PRESSURE
- DIRECT DESTRUCTIVE ACTION OF PUS ON ARTICULAR CARTILAGE
- ISCHEMIA TO GROWTH PLATE DUE TO THROMBOSIS ON THE BOTH SIDE OF THE PLATE
• TREATMENT
- AS SOON AS PUS IS ASPIRATED, DRAINAGE OF JOINT TO PREVENT DAMAGE TO HIP
- RECONSTRUCTIVE HIP PROCEDURE PLANNED LATER

13. TUBERCULAR ARTHRITIS
• LESS COMMON
• IT CAN RESULT FROM
1. Actual infection from M. Tuberculosis which
presents as monoarticular infection
2. From an allergic phenomenon which present as
polyarthritis.

14. INVESTIGATIONS
1. X RAY
NON SPECIFIC
INITIAL STAGE- X RAY ARE NORMAL, GROUND GLASS APPEARANCE
WITH LOSS OF SOFT TISSUE PLANES SEEN

15. INVESTIGATIONS
• LATER STAGE – JOINT SPACE NARROWING

16. 2. USG
• More reliable
• It can diagnose joint effusion in early stages.
• Detects effusion and pus in joint with synovial thickening.
• It can identify plane of collection so that we can differentiate it from
cellulitis and bursitis.
• ECHO FREE – TRANSIENT SYNOVITIS
• POSITIVE ECHOGENICITY – SEPTIC ARTHRITIS

17. 3. SYNOVIAL FLUID ANALYSIS
• NORMAL: HIGH VISCOUS, COLOURLESS, TRANSPARENT
• SEPTIC ARTHITIS:
GROSS : HIGH VISCOSITY AND COLOUR YELLOW OR STROW YELLOW,
OPAQUE
LAB EXAMINATION: WBC COUNT INCREASES,
CULTURE MAY BE POSITIVE
SUGAR LEVEL REDUCED

18. TREATMENT
• SPLINTAGE
The joint must be held in most comfortable position either on splint or
plaster
• GENERAL CARE
Analgesics and iv fluids

19. ANTIBIOTICS
Once the samples are obtained, antibiotics should be started without
without waiting for result
Later they should be changed as per the final report
NEISSERIA (GRAM NEGATIVE DIPLOCOCCI) CEFTRIAXONE
MSSA CEFTRIAXONE
MRSA VANCOMYCIN OR CLINDAMYCINE OR LINEZOLID
STREPTOCOCCUS CEFTRIAXONE
E. COLI, PROTEUS, SERRATIA PIPTAZ
CEFTAZIDIME
PROSTHESIS RELATED (CoNS) THIRD GENERATION CEPHALOSPORIN + VANCOMYCIN

20. TREATMENT
• SURGICAL MANAGEMENT
IMMEDIATE DEBRIDEMENT FOLLOWED BY IRRIGATION WITH NORMAL
SALINE
CAN BE DONE ARTHROSCOPICALLY

21. COMPLICATION
• DEFORMITY AND STIFFNESS
JOINT GETS STIFF DUE TO INTRARTICULAR OR PERIARTICULAR
ADHESION
• OSTEOARTHRITIS
GENERALLY PRESENT LATE

22. COMPLICATIONS
• PATHOLOGIAL DISLOCATION
INFLAMMATORY EXUDATES IN JOINTS INDUCES STRESS IN SUPPORTIVE
LIGAMENTS.
MUSCLE SPASM ASSOCIATED WITH DISEASE LEADS TO PATHOLOGICAL
DISLOCATION

23. COMPLICATION
• POSTERIOR DISLOCATION OF HIP

24. COMPLICATIONS
• TRIPPLE DEFORMITY OF KNEE

25. THANK YOU