Joints become infected through spread
of pathogens from other parts of the
body( haematogenous spread ) or
directly through trauma or surgical
instrumentation, causing septic
4. Risk factors
People at greatest risk include older adults,
particularly those older than 80 years;
people with comorbid conditions such as
diabetes, rheumatoid arthritis, skin
infection, or alcoholism; and people with a
history of a joint replacement or other joint
surgery or IV drug abuse.
S. aureus is the most common cause of joint
infections in all age groups, followed by
other Gram- Positive bacteria, including
Gonococcal infection may cause septic
arthritis through haematogenous spread.
Seen, it tends to afflict young adults
6. septic arthritis
Single knee or hip joints are most commonly infected in Patients with septic
arthritis, although up to 20% of cases involve more than one joint (i.e.,
Prompt recognition and treatment of an infected joint important because
accumulating purulent material may result in chondrolysis (destruction of
hyaline cartilage), and continued hematogenous spread may lead to sepsis and
The overall mortality rate is about 11% and approaches 50% in patients with
polyarticular disease, which may be attributed to the fact that many patients
with septic arthritis are older with a significant comorbidity and/or
7. CLINICAL MANIFESTATIONS
The patient with acute septic
arthritis presents with a warm,
painful, swollen joint with
decreased range of motion.
Systemic chills, fever, and
leukocytosis are sometimes present
8. Assessment and Diagnostic findings
An assessment for the source and cause of infection is performed.
Diagnostic studies include aspiration, examination, and culture of
the synovial fluid.
Computed tomography (CT) and MRI scans may reveal damage
to the joint lining.
Radioisotope scanning may be useful in localizing the infectious
There may not be any external wound or reported recent trauma.
9. MEDICAL MANAGEMENT
Prompt treatment is essential and may save the prosthesis for
patients who have had joint replacement surgery or prevent
Broad-spectrum IV antibiotics are started promptly and then
changed to organism-specific antibiotics after culture results are
The IV antibiotics are continued until symptoms resolve.
The synovial fluid is aspirated and analyzed periodically for
sterility and decrease in WBCs.
10. MEDICAL MANAGEMENT
The primary provider may aspirate the joint with a
needle to remove excessive joint fluid, exudate, and
This promotes comfort and decreases joint destruction
caused by the action of proteolytic enzymes in the
Occasionally arthrotomy or arthroscopy is used to drain
the joint and remove dead tissue
11. MEDICAL MANAGEMENT
The inflamed joint is supported and
immobilized in a functional position by a
splint that increases the patients comfort.
Analgesic agents are prescribed to relieve
The patient's nutrition and fluid status is
12. MEDICAL MANAGEMENT
Progressive range-of-motion exercises are prescribed as
soon as the patient can begin movement without
exacerbating symptoms of acute pain.
If septic joints are treated promptly, recovery of normal
function is expected.
If the articular cartilage was damaged during the
inflammatory reaction, joint fibrosis and diminished
function may result. The patient is assessed periodically
for recurrence over the next year
13. Nursing Management
The nurse educates the patient and family about
the septic arthritis physiologic process and
explains the importance of supporting the
affected joint, adhering to the prescribed
antibiotic regimen, inspecting the skin under any
splints that may be prescribed, and observing
weight-bearing and activity restrictions.
14. Nursing Management
The patient is also educated that recurrence of
infection in the near and far future is possible,
and is educated about signs and symptoms to
observe and report to the primary provider.
The same interventions used for the patient with
osteomyelitis are planned for the patient with
Brunner and Suddarth’s Textbook of Medical- Surgical Nursing
Edition , Volume II , Published by Wolters Kluwer . Page reffered
to 1366- 1367.