Septic arthritis is a joint infection caused by bacteria or other microorganisms. It most commonly affects children and the knee joint. Patients typically present with severe pain, swelling, redness, fever and inability to move the affected joint. Diagnosis involves examination of the inflamed joint as well as imaging, blood tests and joint fluid aspiration. Treatment consists of broad spectrum antibiotics based on fluid culture and sensitivity, immobilizing the joint, and sometimes surgical drainage if pus is present.

2. Ortho II
Presenter Dr Chimpinde
Moderator Dr yubai
Topic Septic Arthritis
Date 03/08/23

3. Contents
• Introduction
• Pathogenesis
• Diagnosis
• Investigations
• Treatment

4. INTRODUCTION:
What is septic arthritis?
-septic arthritis is an inflammatory joint disorder where bacteria or
other microorganisms enter the joint cavity and cause infection.
-septic arthritis is also called infectious arthritis.

5. Anatomy of a synovial joint:

6. -Typically septic arthritis can present as an acute painful arthritis but
may present as subacute or chronic arthritis.
- May be caused by bacterial, viral or fungal.

7. Pathogenesis:
It is more common in children, and Males are more susceptible.
• Staphylococcus aureus is the commonest causative organism;
Other organisms include:Streptococcus, E. Coli, proteus etc.
These organisms reach the joint by one of the following routes:
1. HEMATOGENOUS spread
2. SECONDARY TO NEARBY OSTEOMYELITIS
3. PENETRATING WOUNDS
4. IATROGENIC
5. UMBILICAL CORD SEPSIS

9. Diagnosis:
Diagnosis is mainly clinical. The patient is usually a child. The knee is the
commonest joint affected. Other joints mainly affected are the hip, shoulder,
elbow etc.
CLINICAL FEATURES;
Presenting complaint:
• In its typical acute form;
-the child with septic arthritis presents with a severe pain, swelling and
redness of the affected joint.
-this is associated with high grade fever and malaise.
-child not able to use the affected limb.

10. • Subacute or chronic form:
-the parents may notice that the child isn’t allowing anybody to touch
the affected joint.
-child may not be moving it properly.
-if it’s the lower limb joint, a painful limp maybe the first thing to draw
attention.
-this maybe associated with low grade fever.

11. • In adults:
- Joints are painful, swollen and inflamed.
- Warmth and marked local tenderness & movements restricted.
- Look for gonococcal infections and IV drug abuse
Patients with Rheumatoid arthritis and especially those with on
corticosteroids may develop “silent” infection.

12. On examination:
• Affected joint is swollen and held in a position of ease.
• Palpitation reveals increased temperature, tenderness.
• Severe limitations in the joint movements in all directions.
• Any attempt at either passive or active movements causes severe
pain and Muscle spasms.

13. Investigations:
1. Imagining
2. Blood investigation
3. Joint aspiration

14. Radiological examination:
Diagnosis in early stages is crucial.
• X-rays
• Ultrasound

15. Blood
• Shows neutrophilic leucocytosis.
• ESR & CRP is markedly elevated.
• Blood culture may grow a causative organism ( may be positive)

16. Joint aspiration:
• Is the quickest and best method of diagnosing septic arthritis.
• Synovial fluid examination:

17. Treatment:
• General supportive care:
-Analgesia
• Antibiotics
-whenever suspected diagnosis of septic arthritis must be confirmed or ruled
out by joint aspiration.
- Broad spectrum antibiotics should be started by parenteral route.
- A combination of ceftriaxone and cloxacillin in appropriate doses is given.
- But changed to specific antibiotics as per aspirate culture and sensitivity
reports.
- Joint must be put to rest in a splint or in a traction.

18. • SURGICAL MX
-when pus is aspirated the joint should be opened up (arthrotomy),
wash and closed with a suction drain.