How to manage it

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.