Pathophysiology

Chronic septic arthritis (which is less common) is caused by organisms such as Mycobacterium
tuberculosis and Candida albicans.
The following increase your risk for septic arthritis:
Artificial joint implants
acterial infection elsewhere in your body
Chronic illness or disease (such as diabetes! rheumatoid arthritis ! and sickle cell disease)
"ntra#enous ("$) or injection drug use
%edications that suppress your immune system
&ecent joint trauma
&ecent joint arthroscopy or other surgery
'eptic arthritis may be seen at any age. "n children! it occurs most often in those younger than (
years. The hip is a fre)uent site of infection in infants.
'eptic arthritis is uncommon from age ( to adolescence. Children with septic arthritis are more
likely than adults to be infected with group streptococcus or *aemophilus influen+a.! if not
immuni+ed.
Anatomy and physiology
The knee is the largest joint in the body and is often the site of pain and injury. The joint
is made up of the lower end of the femur (thigh bone) and the upper end of the tibia
(shin bone). The patella (kneecap) slides along a groove on the femur, and covers the
front of the joint. The meniscus and cartilage cushion the spaces between these bones,
and act as shock absorbers during movement.
The quadriceps muscle groups on the front of the upper leg help straighten the leg from
a bent position, while the hamstring muscle group, on the back of the upper leg, help to
bend the knee.
everal large fibrous bands of tissue, called ligaments, support the knee on both sides.
They provide strength and stability to the joint. The four ligaments that connect the
femur and tibia are!
The medial collateral ligament ("#$) provides stability to the inside of the knee.
The lateral collateral ligament ($#$) provides stability to the outside of the knee.
The anterior cruciate ligament (A#$), in the center of the knee, limits rotation and
the forward movement of the tibia.
The posterior cruciate ligament (%#$), also in the center of the knee, limits
backward movement of the tibia.
Tendons are tough cords of tissue that connect muscle to bone. &n the knee, the
quadriceps tendon connects the quadriceps muscle to the patella and helps
provide power to e'tend the leg. The patellar tendon connects the patella to the
tibia.
&ntroduction
eptic Arthritis is acute joint inflammation resulting from bacterial infection. The
most common causative organisms by age group are taphylococcus aureus and group
( streptococcus in patients younger than ) month and . aureus, *ingella kingii, and
group A streptococcus in patients older than ) month. +ther organisms include
,scherichia coli, %roteus, %seudomonas, and -eisseria gonorrhoeae. .oint infection
occurs from hematogenous spread or from e'tension of local osteomyelitis. /estruction
of the joint is believed to occur from inflammation and alteration of the joint fluid by
neutrophil and bacterial to'ins. 0ifty percent of affected patients are younger than 1
years.
eptic Arthritis symptoms. 0indings in affected infants include fever, failure to
feed, tachycardia, subtle changes in position, unilateral swelling of an e'tremity or joint,
asymmetry of soft tissue folds, and pain with joint movement. &n the older child, signs
are more locali2ed and include an erythematous, warm, e'quisitely tender joint with
effusion. The most commonly affected joints are the hip in infants and the knee in older
children.
&n eptic Arthritis aspiration of the joint is indicated, and synovial fluid is sent for
chemistries, cell count, 3ram stain, and culture and sensitivities. 0indings include
serosanguinous4turbid fluid, a white blood cell count of 56,777 to 567,77748$, more than
96: neutrophils, low viscosity, increased complement, low glucose, elevated lactate,
and the presence of bacteria. %eripheral blood cultures should also be performed.
;adiologic evaluation, including '<ray, computed tomography, magnetic resonance
imaging, and radioisotope scans, may be helpful.