Septic Arthritis| Diagnosis, Management.

Understanding Septic Arthritis: Diagnosis, Treatment, and Management

Description: This comprehensive PDF presentation offers an in-depth look at septic arthritis, a serious joint infection that can cause severe pain and complications if not treated promptly. The document covers essential topics such as:

Pathophysiology of septic arthritis
Common causes and risk factors
Clinical presentation and symptoms
Diagnostic techniques, including lab tests and imaging
Treatment options, including antibiotics and surgical intervention
Management strategies for long-term care and prevention of complications
This resource is designed for healthcare professionals, medical students, and anyone interested in learning more about septic arthritis. It provides clear, evidence-based information that can be used for educational purposes or as a quick reference in clinical practice.

Keywords: Septic Arthritis, Joint Infection, Diagnosis, Treatment, Management, Pathophysiology, Antibiotics, Surgery, Clinical Practice, Medical Education.

1. SEPTIC ARTHRITIS
Dr. Bharat Pokhrel

2. DEFINITION
Septic arthritis is an acute pyogenic infection of synovial joints.
Orthopedic emergency with potential high morbidity
and mortality.

3. EPIDEMIOLOGY
The global incidence of septic arthritis ranges from 2 to 10 cases per 100,000
person-years in the general population.
In children under 5 years, the incidence is higher, ranging from 4 to 29 cases per
100,000 person-years.
Among adults over 60 years of age, the incidence is estimated to be 10 to 30 cases
per 100,000 person-years.
Mathews, C. J., Weston, V. C., Jones, A., Field, M., & Coakley, G. (201). Bacterial septic arthritis in adults. The Lancet, 375(9717), 846-855.

4. The knee is the most commonly affected, but any joint may be involved.

5. PREDISPOSING FACTORS
Pre-existing joint diseases (Rheumatoid Arthritis, Osteoarthritis)
Diabetes Mellitus
Recent joint surgeries.
IV drug abuse
Immunosuppressive medications
Advanced age (>80)
HIV/AIDS and other chronic conditions.

6. ETIOLOGIES
AGE GROUP CAUSATIVE ORGANISMS
NEONATES Streptococcus sp., Gram Negative organisms
INFANTS Staphylococcus aureus
H. influenza
CHILDREN Staphylococcus aureus
Salmonella
ADOLESCENT S. Aureus
N. gonorrhea
ADULTS Staph aureus, Streptococcus, Gram negative organisms
IV DRUG USERS Pseudomonas and atypical organisms

7. PATHOGENESIS

8. MECHANISM OF INFECTION
Most commonly, septic arthritis arises via hematogenous seeding of the
synovial membrane (which has no limiting basement membrane, thus
allowing organisms (S.aureus) to enter the joint space)
 Large joints are most commonly affected by this type of hematogenous
seeding.

9. MECHANISM OF INFECTION

10. CLINICAL MANIFESTATIONS
Throbbing pain, Hot, tender, swollen joint (Monoarticular arthritis)
Restricted movement +/- fever
In children, irritable, refused feeding, tenderness, warmth, rapid pulse
Elevated WBC,ESR,CRP common but non specific.

11. SIGNS
In neonates
Few clinical signs
Child may not have fever
Loss of spontaneous movement of
extremity
In children; signs of local inflammation
are present
Rapid pulse and swinging fever
Overlying red skin
Swelling may present
Local rise of temperature and marked
tenderness over joint
All movements of joints restricted

12. SIGNS
In adults
Often a superficial joint (knee, wrist or
ankle)
Joint is painful, swollen, and inflamed
Movements on affected joint is
restricted

13. PHYSICAL EXAMINATION
Decreased or absent range of motion
Sign of inflammation; joint swelling, warmth, tenderness and erythema
Joint orientation as to minimize pain(position of comfort);
➢ Hip; abducted, flexed and externally rotated
➢ Knee, ankle and elbow; partially flexed
➢ Shoulder; abducted and internally rotated

14. DIAGNOSIS: GENERAL APPROACH
Septic arthritis should be considered in any patient with a sudden or
gradual onset of at least one swollen, painful joint, with or without any
relevant risk factors (such as bacteremia, pre-existing joint disease, and
immunosuppression).
A joint aspiration should be promptly conducted thereafter.

15. DIAGNOSIS: IMAGING
X-RAY
Early stage: usually normal
Later on-joint space widening may be present, soft tissue shadow
corresponding to distended capsule due to swelling of joint
Late stages: Narrowing and irregularities of joint space with periosteal
reaction, bone destruction and sequestrum formation can be seen.

16. FOR REFERENCE

17. REFERENCE

18. FOR REFERENCE

19. DIAGNOSIS: IMAGING
ULTRASONOGRAPHY
➢Can be used to detect even the smallest amount of joint effusion
➢non invasive, inexpensive, and easy to use
➢Can be used to guide joint aspiration

20. DIAGNOSIS: IMAGING
MRI
➢Can detect infection and extent of infection
➢Useful in diagnosing infections that are difficult to access
➢Also useful in differentiating between bone and soft tissue infection and
detection of joint effusion

21. BLOOD INVESTIGATION
Leucocytosis > 12,000
ESR->40 MM/HR
CRP-elevated
Blood culture-may be positive

22. JOINT ASPIRATION-SYNOVIAL FLUID EXAMINATION
Quickest and best method of diagnosing septic arthritis
In early stage –fluid may be clear
Normal synovial fluid leucocyte count-under 300/ml
Leucocyte count >50,000 per ml with 90% PMN strongly suggestive of
septic arthritis

23. SYNOVIAL FLUID EXAMINATION

24. DIFFERENTIAL DIAGNOSIS
Inflammatory conditions Other causes of arthritis
•Acute Osteomyelitis
•Acute lymphadenitis
•Acute Bursitis
•Rheumatic arthritis
•Hemophilia
•Tubercular arthritis
A case with an acute septic arthritis should be differentiated from the following conditions

25. WHAT IS NEXT?

26. TREATMENT
IN EARLY STAGE
A correct diagnosis and aggressive treatment can save joint from permanent
damage
Whenever suspected, diagnosing septic arthritis must be confirmed or ruled out by
joint aspiration
Broad spectrum antibiotics should be started-combination of ceftriaxone and
cloxacillin usually given.

27. TREATMENT

28. TREATMENT
IV fluids-to prevent dehydration
Analgesic-for pain
Joint must be put to rest in a splint or in traction
When pus is aspirated, joint should be opened up
(arthrotomy),washed and closed with suction drain.

29. TREATMENT
LATE CASE
With radiological destruction, of joint margins, subluxation or dislocation is
not possible to expect joint movement
After an arthrotomy and extensive debridement of the joint, it is immobilized in
the position of optimum function, so that as the disease heals, ankylosis
occurs in that position.

30. COMPLICATIONS
DEFORMITY AND STIFFNESS ( bony ankylosis)
PATHOLOGICAL DISLOCATION(posterior dislocation of hip and triple
displacement of knee)
OSTEOARTHRITIS

31. THANK YOU