SEPTIC ARTHRITIS

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DEFINITION
• WHAT IS SEPTIC ARTHRITIS?
Septic arthritis is an inflammation of synovial membrane with purulent effusion into the joint
capsule due to infection
• Also referred as infectious arthritis
• Septic arthritis is a key consideration in adults presenting with acute
monoarticular arthritis.
• Considered as MEDICAL EMERGENCY
• Failure to initiate appropriate antibiotic therapy within the first 24 to 48 hours
of onset can cause subchondral bone loss and permanent joint dysfunction.
• It can cause septic shock, which can be fatal. TIMMERMAN
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 ANATOMY
SYNOVIAL JOINT
• Synovial membrane:
• Lines joint & cavity and secretes synovial fluid
for lubrication
• Articular cartilage:
• Prevents grinding of the bone and allow for
smooth articulation
• Fibrous capsule:
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• Protection of joint cavity INDUSTRIES
EPIDEMIOLOGY
• The prevalence of bacterial arthritis as the diagnosis among adults presenting with one or more
acutely painful joints has been estimated to range from 8% - 27%
• All age groups, infants and older adults are most likely to develop septic arthritis.
• 50% < age 3
• Male = Female
• The knee is the most commonly affected (40-50%)
• -hip: 20-25% *common in infants
• -wrist: 10%
• -shoulder, ankle, elbow: 10-15%.
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AETIOLOGY

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AETIOLOGY & RISK FACTORS

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PATHOPHYSIOLOGY
• HEMATOGENOUS SPREAD
Most common form of spread, usually affects people with
underlying medical problems.

• DIRECT INNOCULATION
May result from penetrating trauma, introduction of organisms
during diagnostic and surgical procedures.
E.g. intra-articular injection.

• DIRECT SPREAD FROM ADJACENT BONE

More common in children. Osteomyelitis usually begins in the metaphyseal
region, from which it breaks through the periosteum into the joint TIMMERMAN
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PATHOLOGY

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 CLINICAL FEATURES
Newborn infants
• More on septicaemia Rather
than joint pain
• Baby is irritable & refuse to
feed
• Tachycardia with fever
• Joints are warmth, tenderness,
resistance to movement
• Umbilical cord and inflamed IV
site should be suspicious of
source of infection
Children
• acute pain in single large joint
• Pseudoparesis
• Child is ill, rapid pulse and
swinging fever
• Overlying skin looks red &
superficial joint swelling may be
obvious
• Local warmth and marked
tenderness
• All movements are restricted by
pain or spasm.
• Look for source of infection from
septic toe or discharge ear
Adult
• Often in the superficial joint(knee,
wrist or ankle )
• Joints painful, swollen & inflamed.
• Warmth and marked local
tenderness & movement restricted.
• Look for gonococcal infection or
drug abuse.
• Patient with rheumatoid arthritis
and especially those on
corticosteroid may
• Develop “silent” joint infection.
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Ravn et al.: Guideline for management of septic arthritis in native joints (SANJO)
INVETIGATIONS
1. BLOOD INVESTIGATIONS 3. SYNOVIAL FLUID ANALYSIS
• Raised WCC
• Raised ESR and CRP
• Blood culture (positive)

2. IMAGING
• USG is the most reliable method for joint effusion. Widening of space
between capsule and bone of more than 2mm is indicative effusion
• X-ray
• Early stage: May look normal, sign to be watched: soft tissue swelling, loss
of tissue plane, widening of joint space, slight subluxation because of fluid
in the joint
• Late stage: Narrowing and irregularity of joint space; may have OM
changes of adjacent bones

• MRI and radionuclide imaging are helpful in diagnosing arthritis in obscure

sites
• such as the sacroiliac and sterno-clavicular joint. TIMMERMAN
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FINDINGS
X-Ray - Knee X-Ray – Hip Joint

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FINDINGS
Ultrasound - Hip

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FINDINGS
SYNOVIAL FLUID ANALYSIS
• Aseptic technique is used during aspiration of synovial
fluid.
• After infiltrating the skin with local anaesthetic, a 20-
gaugle needle is introduced and a sample of joint fluid is
aspirated (<0,5ml enough to diagnosis analysis)
• The fluid is then analyzed by gross and microscopic
examination and culture.

• Gross examinations include appearance, volume, viscosity,

mucin clotting (amount of proteoglycans).
• Microscopic examinations include leucocyte count,
staining of smears, serum glucose ratio, protein.
• Finally, culture and sensitivity for definitive diagnosis and
treatment.

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TREATMENT
• 1st priority – aspirate the joint and examine the fluid
• Treatment started without further delay
• General supportive care – analgesics and IV fluid

• 1. DRAINAGE
• Young infant and hip joint involved
• Older children and any joint except hip

• 2. ANTIBIOTICS
• Neonates and infants up to 6 months – penicillin ( flucloxacillin) + 3rd gen cephalosporin
• Children from 6 months to puberty – similar to above.
• Older teenager and adults – flucloxacillin and fusidic acid and 3rd generation cephalosporin
• Antibiotics given IV for 4-7 days, then orally for 3 weeks.

• 3. SPLINTAGE
• Joint should be held abducted and 30 degrees flexed on traction to prevent dislocation

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COMPLICATION
• 1st priority – aspirate the joint and examine the fluid
• Treatment started without further delay
• General supportive care – analgesics and IV fluid

1. Early
• Death from associated septicaemia
• Destruction of joint cartilage
• Pathological dislocation of joint
• Avascular necrosis of the

2. Late
• Degenerative joint disease
• Permanent dislocation
• Fibrous ankylosing
• Bony ankylosing

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Thank you!

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