Septic arthritis is an infection-induced inflammation of the synovial membrane, primarily caused by bacteria such as Staphylococcus aureus, affecting patients of all ages and commonly impacting the hip and knee joints. Key clinical features include fever, joint swelling, pain, and restricted movement, with a diagnosis involving radiographic and laboratory tests to assess joint fluid and infection indicators. Treatment includes antibiotics, supportive care, possible surgical intervention, and physiotherapy to manage symptoms and restore joint function.

1. - Shaikh Yumna
SEPTIC ARTHRITIS

2. INTRODUCTION
 Septic arthritis is an inflammation of synovial
membrane with purulent effusion into the joint
capsule due to infection
 Also referred as Infectious arthritis
 It is commonly caused by Staphylococcus aureus,
N.gonorrhea and less commonly by streptococci,
pneumococci, gonococci etc.
 Seen in every age group ,M=F.
 Common sites-hip joint in childrens ,knee joint in
adults.

3.  It is caused by the invasion of bacteria ,viruses or fungi into
the synovial membrane of a joint.
 May also begin as the result of an open wound , trauma
,surgery, or unsterile injection.
AETIOLOGY

4.  Age>80 years old.
 Medical conditions-OA,RA,gout,diabetes HIV.
 Weak immune system.
 Recent joint surgery.
 IV drug use.
 Immunosuppressive drug therapy.
RISK FACTORS

5. HAEMATOGENOUS
DIRECT
IMPLANTATION
OF THE BACTERIA
IATROGENIC
SECONDARY TO
OSTEOMYELITIS TO
ADJACENT BONE

6. Inflammation of the synovial membrane
Bacteria enters the body
triggers inflammatory process
inflammation of the synovial membrane with excessive
production of joint fluid/pus
Fluid contains a large no. of cells, bacteria and fibrin
Formation of pus in the joint followed by erosion and
destruction of articular cartilage and the bone.
PATHOGENESIS

7. Pathologic dislocation may occur
The capsule may get perforated and pus may escape out
forming a sinus.
If untreated, joint may get disorganized and lead to fibrous or
bony ankylosis.

8.  H/O recent trauma /infection.
 High grade fever.
 Painful , swollen and inflamed joint.
 Warmth and marked local tenderness.
 Restricted movements of affected joint due to pain
and muscle spasm.
CLINICAL FEATURES

10.  Commonly seen in children younger than 1 year.
 occurs due to spread of infection from the neighbouring bone
lesion or from a septic umbilicus.
 Clinical features:-
Fever.
painful hip.
unable to move the limb
swelling and tenderness around the hip
occasionally in late presentations, the child may present with
a limp when he/she begins to walk
limb shortening (indicative of head destruction)
resembles the condition CDH.
ACUTE SEPTIC ARTHRITIS OF INFANCY
(TOM SMITH ARTHRITIS)

11.  Investigations
 Radiography
complete loss of head and neck of femur function with poorly
developed acetabulum
there is marked upriding of the trochanter with absence of
femoral head and neck

13. Laboratory testing includes WBC count,ESR
and CRP.These values are usually elevate
in those with septic arthritis.
INVESTIGATIONS

14.  X-ray –
Early radiographs may be normal or may show
increased joint space d/t fluid or pus collection.
Late radiographs show destruction of the cartilage ,
new bone formation ,and eventually bony ankylosis or
even pathological dislocation.
 Ultrasonography-
To detect collection of fluid in the joint.
INVESTIGATIONS

15. Synovial fluid analysis- technique is done by
aspiration of synovial fluid from the affected
area

18.  Medical treatment-
General supportive care- Analgesics and IV Fluid
Antibiotic drugs are started at the earliest
Rest to the joint by traction or splinting or POP
slab.
In neonates and infants,with hip infection the joint
is held abducted and 30°flexed
MANAGEMENT

19.  Once the cultures are available , antibiotics is started ,to
target the specific organism
S.aureus - cefazolin/vancomycin
N.gonorrhea-cefriaxone
Gram negative bacilli- 3rd gen. cephalosporin+aminoglycoside.

20.  Surgical treatment-
Aspiration
Arthrotomy:(incision into a joint that may be
used in drainage)
- Done as early as possible to prevent
permanent damage to the articular cartilage
- Debridement

21. Physiotherapy treatment-
Primary aims
Patient education about the exercise and the
management of their condition.
Reduce pain.
Restore and maintain physiological function.

22. Interventions
 Electrotherapy modatilies –Ice, hydrotherapy, heat, TENS
,IFT, Ultrasound.
 Cold- useful in the acute phase or active period of
inflammation. Application of cold produces local analgesia,
increase superficial circulation at the site of application and
decrease intra articular temperature.
10-20mins 1-2 times a day
 Heat-useful in chronic phase. Provides pain relief, reduces
muscle spasm and improves the elasticity of soft tissues.
20-30mins 1-2 times a day

23. Gentle assisted movements through the joint range
should be started to prevent contractures
Isometrics “static muscle contraction” exercises to
maintain muscle tone without increasing
inflammation
Strong movements of the adjacent joints .
Assisted functional training task and compensatory
methods to facilitate ADLs
Orthotic device

24.  Gait training with walker
Position the walker in front of the patient
Assist the patient to a standing position
patient leans forward ad pushes up with the arms from the
chair arm rest/ bed to come to stand
Instruct the patient to position his/her body within the frame of
the walker and ask the patient to grasp the hand rest
Instruct the patient to move the walker forward by lifting it
up,moving it forward and setting it down
Instruct the patient to take a step forward with the weak leg
Then ask he patient to move His/her strong leg forward
Instruct to take short steps ,keep head up and eyes looking
forward

25. Returning to sit
As the patient approaches the chair /bed , the patient turns in
small circles towards the stronger side
Ask the patient to move backwards until the chair /bed can be
felt against the patients leg
Then the patient lowers to the chair/bed in a controlled manner

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