Septic arthritis

Introduction
Septic arthritis is also known as joint sepsis infected by

a. Direct invasion through penetrating wound

b. Direct spread from an adjacent bone abscess

c. Blood spread from a distant site

Causative organism
Most commonly the causative organism is Staphylococcus aureus.

Haemophilus Influenzae is the most common organism found in children; in the

age group of 1 – 4 years.

Other organisms encountered are Streptococcus, E.coli, and Proteus.

Pathology
The infection spreads through blood
and settles in the synovial membrane

Acute inflammatory reaction with a

serous exudate and increase in
synovial fluid.

The appearance of pus in the joint

with the erosion of the cartilage by the
bacterial and proteolytic enzymes
In children, the epiphysis is entirely cartilaginous and gets severely damaged
and in older children, vascular occlusion may lead to necrosis of the epiphyseal
bone. In adults, the effects are confined to the articular cartilage.

The untreated infection leads to the spread of the underlying bone or burst out
of the joint to form an abscess.
Clinical features
Clinical features are according to the age of an individual
In newborn infants:
The baby is irritable and refuses to feed.
Fever
Rapid pulse
Warmth, tenderness, and resistance to movement.
In children:
Acute pain in a single large joint (Hip or knee)
Reluctance to move the joints (Pseudoparesis)
Rapid pulse and swinging fever
Swelling and redness
Local warmth and tenderness
All movements are restricted due to pain
In adults:
Swollen, painful, and inflamed joint.
Warmth and tenderness
Movements are restricted.
Imaging
Ultrasonography is the most reliable method for determining joint effusion in the early
stages. Both sides need to be compared. Widening of the space between the capsule and
bone of more than 2mm is indicative of joint effusion.

X-ray: Widening of the joint space and slight subluxation. Narrowing and irregularities
are the late features.

MRI and Nucleotide imaging: Helpful in the diagnosis of sacroiliac and sternoclavicular
joints arthritis.
Investigations
Blood test: WBC count and ESR is raised.
Aspiration and joint fluid examination
 Treatment
General suppurative care
Analgesics and intravenous fluids
Splintage
Joint splinted in the resting position for infants and with hip infection to be held in
abduction and 30 of flexion.
Antibiotics
Neonates up to 6 months- Penicillin (Flucloxacillin) and third-generation
cephalosporins
Children up to 6 months to puberty- Penicillin, and cephalosporins
Teenagers and adults: Can be started with flucloxacillin and fusidic acid.
Antibiotics are to be given intravenously for 4-7 days and then orally for 3 weeks.
Drainage
After care
It includes gentle and gradually increasing active movements. In case of damaged
cartilage, keep the joint immobile. Splintage is to be performed as well.
Complications
Subluxation and dislocation of the hip
Damage to the epiphysis
Retarded growth
Deformity of joints
Epiphyseal osteonecrosis
Acetabular dysplasia
Pseudoarthrosis of hip
Chondrolysis