SEPTIC ARTHRITIS
 
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SEPTIC ARTHRITIS

 

DEFINITION:

A disorder of the joint where the joint capsule is infiltrated with bacteria.

EPIDEMIOLOGY:

  • incidence: ?
  • age of onset:
    • most common in the first 6 years
  • risk factors:
    • see below

PATHOGENESIS:

  • bacterial infection of the joint space from
    • hematogenous spread
    • direct innoculation (foreign body)
    • extension from adjacent osteomyelitis
  • organisms:

Age(years) - Organism

  • 0-.5 years - S. aureus, Group B Strep., E. coli
  • .5-3 years - S. aureus, H. flu (b)
  • 3-6 years - S. aureus, H. flu (b), Group A Strep., pneumococcus
  • over 6 years - S. aureus, H. flu (b), Group A Strep. , meningo.
    • site of infection
      • knee > hip > ankle > elbow > wrist > shoulder 40 : 20 : 15 : 15 : 5 : 5%

    CLINICAL FEATURES:

    1. Joint

    • rapid onset of joint pain
    • held in flexion around affected joint
    • signs/symptoms of inflammation (erythema, swollen, warm, painful)
    • signs/symptoms of systemic symptoms (fever, malaise, etc)
    • neonates - pseudoparalysis or disuse of limb
    • children - disuse or limp

    2. Complications

    • arthritis (joint cartilage destroyed)
    • avascular necrosis of femoral head
    • osteomyelitis
    • septic dislocation

    INVESTIGATIONS:

    1. Serum

    • leukocytosis with left shift
    • increased ESR
    • blood cultures (positive in 50% of cases)

    2. Joint Aspiration

    • gram stain, culture, >40,000 PMN (>90% neutrophils), pus

    3. Imaging Studies

    1. Skeletal X-Rays

    • increased size of joint space (no change in 1st 10 days)

    2. Bone Scan

    • increased uptake of Ga, ? osteomyelitis, ? viability of femoral head

    MANAGEMENT:

    1. Medical

    • IV antibiotics for 7 -> 14 days
    • Cloxacillin or Cefuroxime

    2. Surgical

    • immediate incision and drainage of hip (ortho emergency)
    • multiple aspirations or arthroscopic lavages

     

     

     

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