2. A joint inflammation due to an infection usually involving
the synovial joints
50% cases - children less than 5 years
30% cases - children less than 2 years
Most dangerous and destructive monoarthritis
Can destroy cartilage within days
Mortality 7-15 % despite antibiotic use
6. Can be bacterial, fungal, mycobacterial or viral
Bacterial divided into
gonococcal –more common less morbid
Immosupressive therapy or disorders
Chronic debilitating disorders – CLD, RF
11. Previous joint trauma
h/o arthritis to same joint
Degenerative joint disease
13. Bacteria rapidly gains access to the joint cavity and settles in the synovial
Acute inflammatory reaction occurs with formation of serous or seropurulent
Articular cartilage is eroded and destroyed due to the action of bacterial toxins
and by enzymes released from the synovium and inflammatory cells.
In late cases- extensive erosion due to synovial proliferation and ingrowth.
14. If untreated- spread to the underlying bone or burst out of the joint to form
abscesses and sinuses.
1. Complete resolution.
2. Partial loss of cartilage and fibrosis of joint.
3. Loss of articular cartilage and bony ankylosis.
4. Bone destruction and permanent deformity of the joint.
FEW CLININCAL SIGNS
May not be febrile
Loss of spontaneous movement of extremity
Hip- flexion, abduction, eternally rotated
18. In children
Local signs of inflammation
Rapid pulse and SWINGING FEVER
All joint movements - RESTRICTED
19. In adults
Often a superficial joint – knee, ankle, wrist
Joint is painful, swollen, inflamed
Restriction of movements
20. 1. Decreased or absent range of motion.
2. Signs of inflammation: joint swelling, warmth,tenderness and erythema.
3. 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
23. In early stages- usually normal.
Later on- joint space widening may be present and subluxation of the joint may be
In late stages- irregularity of the joint.
28. 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.
30. In early cases- fluid may be clear.
Sample sent for Gram staining, microscopy,
culture, and antibiotic sensitivity.
Normal synovial fluid leucocyte count: under
Leucocyte count>50,000 per ml with 90%
PMN strongly suggestive of septic arthritis.
35. Can detect infection and extent of infection.
Useful in diagnosing infections that are difficult
Also useful in differentiating between bone and
soft tissue infections and in detecting joint
38. IV fluids- to prevent dehydration.
Analgesics- for pain.
Joint must be rested either on splint or in a widely split plaster.
39. Broad spectrum IV antibiotics are started immediately and then depending on
microbiological investigations, specific antimicrobial therapy is started.
40. Duration of treatment: IV antibiotics given for minimum of 2 weeks.
Adults- 4-6 weeks.
41. 1-Joints that do not respond to antimicrobial therapy and daily arthrocentesis
2-.Any joint with limited accessibility, including the sternoclavicular or the hip joint
3-Patients with underlying disease, including diabetes, rheumatoid arthritis,
immunosuppression, or others systemic symptoms, should be treated more
aggressively with earlier surgical intervention
42. In septic arthritis of hip- surgical drainage is always done.
Joint is opened through a small incision and washed with normal saline.
Small drain is left in place after incision is closed.
Suction-irrigation is continued for another 2 or 3 days.
43. In knee- arthroscopic debridement and copious irrigation.
In adults- repeated closed aspiration of joint may be done.
But if no improvement within 48 hours- open drainage is necessary.
45. Non gonococcal bacterial arthritis is a dangerous and destructive form of acute
Risk factors include pre-existing joint disease, joint replacement, old age,
immunosuppression and overlying infection or ulceration
It usually presents as monoarthritis involving a large joint like the knee
Because symptoms such as fever may be absent and tests such as FBC and CRP are
non specific, joint aspiration is necessary to establish the diagnosis- for cell count,
microscopy and culture. BC are also useful
Staph and strep are the most common pathogens and are usually treated with
flucloxicillin, but older patients, ICU patients, IVDUs may have gram-ves and
given3rd gen cephalosporin
Joint drainage- by needle aspiration or surgical means should also be considered