Brief Overview on Septic Arthritis and Arthroscopy

1. MANAGEMENT OF
CHRONIC SEPTIC
ARTHRITIS:- POST
ARTHROSCOPY
Case Presentation
By: Chrystal Lynch
FirstYear PhysicalTherapy Student

2. OBJECTIVES
• To provide a brief overview of the anatomy of the knee.
• To define septic arthritis.
• To provide a brief incidence of septic arthritis.
• To explain the aetiology and pathology of septic arthritis.
• To provide the signs and symptoms of septic arthritis.
• To describe the medical and surgical management.
• Introduction of patient’s case.
• To describe the physical therapy management

3. ANATOMY OFTHE KNEE JOINT
• The knee joint, also known as the tibiofemoral joint, is a synovial
hinge joint formed between three bones, the femur, the tibia and
the patella.

4. • In-between the distal femur and proximal tibia, is a fibrocartilage
called the meniscus.

5. • The joint capsule that surrounds the bones of the knee, provide
strength and lubrication. It also produces an oily fluid that fills
hollow spaces of the joint, lubricating the knee to reduce friction
and wear.

6. •LIGAMENTS:
Patellar Ligament:
 Distal portion of the Quadriceps Femoris Tendon
 Insertion: Tibial Tuberosity

7. The Medial Collateral Ligament:
Origin: Medial Epicondyle of Femur.
Insertion: Medial surface of the body of the tibia.
Function: Prevents excessive abduction of the knee.
The Lateral Collateral Ligament:
Origin: Lateral Epicondyle of Femur.
Insertion: Head of Fibula.
Function: Prevents excessive adduction of the knee.

9. Anterior Cruciate Ligament:
Origin: Anterior part of the tibial plateau
Insertion: Posteromedial aspect of the lateral femoral
condyle.
Function: Prevents excessive posterior movement of the
femur on the tibia.

10. The Posterior Cruciate Ligament:
Origin: Posterior part of the tibial intercondylar area
Insertion: Anterior lateral aspect of the medial femoral
condyle
Function: Prevents excessive anterior movement of the
femur on the tibia.

12. •MUSCLES:
The Quadriceps:
 Location: Anterior thigh, from hip to knee
 Action: Extends the leg

13. The Hamstrings:
Location: Posterior thigh, hip to knee
Action: Flexes the knee

14. Gastrocnemius:
Origin: Lateral condyle of femur (lateral head) and Medial
condyle of femur (Medial head).
Insertion: Posterior surface of the calcaneus as the Achilles
Tendon
Action: Flexes the Knee

16. SEPTIC ARTHRITIS
• Septic Arthritis: Painful, inflammation of a joint due to an
infection. If left untreated for a long period, it can prove to be very
destructive to the joint and cause severe illness.

17. AETIOLOGY
• Septic Arthritis can be caused by bacteria that comes from another
area of the body or from a bacterial infection, that is resulting from
an open wound or opening from a surgical procedure.
• Most cases of acute septic arthritis is caused by bacteria such
as staphylococcus aureus or streptococcus
• Chronic septic arthritis caused by organisms such as
mycobacterium tuberculosis and candida albicans.

18. PATHOLOGY
• The most common route for the bacterial spread is
hematogenuous.
• An inflammatory reaction is produced rapidly when the bacteria
enters the joint and deposits in the synovial membrane.
• The inflammation results in an increase of white blood cells in the
synovial fluid.
• The longer septic arthritis is left untreated, the more destruction to
the joint occurs due to the microorganism/s.

19. INCIDENCE
Septic Arthritis:
• In Western Europe:
 4-10 cases per 100,000 patient-years per year
• In Industrialized Countries:
6 per 100,000 of population per year
• Patients with underlying joint disease or prosthetic joint:
30 – 60 per 100,000 of population per year

20. • Persons at Risk for Septic Arthritis:
Young children, adolescents and the elderly.
Patients with diabetes, diabetes or any other pre-existing
conditions.
Patients on haemodialysis.
Intravenous drug users.
Persons whose immune system is weakened
Chronic Arthritis
History of steroid injections into the joint
History of previous surgeries on the joint
Infection in another part of body

21. SIGNS AND SYMPTOMS
• Chills
• Joint is warm to touch
• Joint is red
• Fatigue and generalized weakness
• Fever
• Inability to move the limb of the affected joint
• Severe pain of the affected joint
• Swelling

22. MEDICAL AND SURGICAL MANAGEMENT
oAntibiotics
• Intravenously
• Tablets
oNSAIDs
oAntifungal Medication
oResting the Joint

23. oArthroscopy: this a surgical orthopedic procedure performed on a
joint, where the joint is viewed using a small camera. It is done
through small incisions into the joint. – The American Orthopedic Society for Sports Medicine.

25. oArthroscopic Lavage: clear sterile solution used to fill joint and
rinse away any cloudy contents (blood, fluids or loose debris). It is
usually combined with arthroscopic debridement. – Ontario Health
Technology Advisory Committee Recommendations: Arthroscopic Lavage and Debridement for Osteoarthritis of the
Knee

26. • Girth Measurements:
RIGHT LEFT
33.5cm 10cm above
superior border of
the patella
34.5cm
31cm Superior border of
Patella
33.5cm
36.1cm 10cm below
superior border of
the patella
37.5cm