Thursday 4 October 2012

Septic arthritis

Aetiology

  • Direct injury
  • Blood-borne infection
  • Susceptibility in
    • Chronically inflamed joints
    • Immunosuppressed patients
    • Artificial joints

Organisms
  • Staphylococcus aureus
  • Streptococcus and other staphylococci
  • Neisseria gonorrhoeae
  • Haemophilus influenzae
  • Gram-negative organisms

Clinical features
  • Joint pain (may be severe)
  • Muscle spasm
  • Joint hot, red and swollen
  • Signs of the source of infection

Investigations
  • Urgent joint aspiration
    • Microscopy and culture/gram stain
  • Elevated white cell count
  • Blood cultures

Management
  • Two i.v. antibiotics for 2 weeks (start antibiotics immediately diagnosis suspected)
  • Followed by 6 weeks of oral antibiotics
  • Initial mobilisation of the joint
  • Early physiotherapy
  • Consider surgical drainage and washout

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