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.
If untreated- spread to the underlying bone or burst
out of the joint to form abscesses and sinuses.
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
Clinical Features- Symptoms
Pain over joint.
Reluctance to move joint(pseudoparesis).
Few clinical signs.
Child may not have fever.
Loss of spontaneous movement of extremity.
Hip-flexion, abduction, and external rotation.
In children: signs of local inflammation are present.
Rapid pulse and swinging fever.
Swelling may be present.
Local rise of temperature and marked tenderness
All movements of joint- restricted.
Often a superficial joint( knee, wrist or ankle).
Joint is painful, swollen, and inflamed.
Movements are restricted.
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
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.
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.
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.
Duration of treatment: IV antibiotics given for
minimum of 2 weeks.
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
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
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.
Septic arthritis of the hip.
Seen in infants.
Head of femur is completely destroyed by the
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
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.
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.