2. SEPTIC ARTHRITIS
A joint inflammation due to an infection usually
involving synovial joints.
More common than osteomyelitis
Common age group 1month to 5 yrs
50% of cases- children less than 5 years.
30% of cases- children less than 2 years.
Single joint involvement 94% of cases
3. Common site of involvement
5. Predisposing factors
LOCAL FACTORS GENERAL FACTORS
H/o arthritis to the
Crystal induced joint
disorders- liver failure
and renal failure
6. Mode of spread
2. Direct invasion.
3. Aspiration , surgery,
5. Local spread from
6. Spread from
Bacteria rapidly gains access to the joint cavity and
settles in the synovial membrane.
Acute inflammatory reaction occurs with formation of
serous or seropurulent exudate.
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.
If untreated- spread to the underlying bone or burst
out of the joint to form abscesses and sinuses.
8. HEALING PROCESS
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
9. Clinical features
Pain over joint.
Reluctance to move
Few clinical signs.
Child may not have fever.
Loss of spontaneous movement of
Hip-flexion, abduction, and external
10. IN CHILDREN:
signs of local inflammation are present.
Rapid pulse and swinging fever.
Swelling may be present.
Local rise of temperature and marked tenderness
All movements of joint- restricted.
Often a superficial joint( knee, wrist or ankle).
Joint is painful, swollen, and inflamed.
Movements are restricted.
11. Physical examination
1. Decreased or absent ROM.
2. Signs of inflammation: joint
swelling, warmth, tenderness
3. Joint orientation as to minimize
pain (position of comfort):
Hip: abducted, flexed and
Knee, ankle and elbow:
Shoulder: abducted and
12. D/D WITH OSTEOMYELITIS
warm joint with painful gentle passive motion–
joint motion usually doesn’t exacerbate
symptoms in O.M
D/D WITH TRANSIENT SYNOVITIS
13. TRANSIENT SYNOVITIS
m/c/c of hip pain in children
Kocher and collegues identified 4 independent
predictors to d/d b/w septic arthritis v/s transient
1. Fever >38.5 C (best predictor)
2. h/o non weight bearing
3. WBC > 12000cell / mm3
4. ESR > 40 mm/ hr
USG and arthrocentesis are best for diagnosis
Can be used to detect even the
smallest amount of joint effusion.
Non invasive, inexpensive and easy
Can be used to guide joint
19. JOINT ASPIRATION
In early cases- fluid may be clear.
Sample sent for Gram staining,
microscopy, culture, and antibiotic
Normal synovial fluid leucocyte count: <
Leucocyte count>50,000 per ml with 90%
PMN- strongly suggestive of septic
Can detect infection and extent of infection.
Useful in diagnosing infections that are difficult to
Also useful in differentiating between bone and
soft tissue infections and in detecting joint
Joint must be rested either on splint or in a widely
Broad spectrum IV antibiotics are started
immediately and then depending on
microbiological investigations, specific
antimicrobial therapy is started.
First line antibiotics: Benzyl penicillin,
flucloxacillin, and augmentin.
Second line antibiotics: Vancomycin,
Clindamycin, Fusidin, and Teicoplanin.
Hemophilus infection- cephalosporins.
24. Duration of treatment: IV antibiotics given for
minimum of 2 weeks.
Adults- 4-6 weeks.
Indication of Surgical Drainage:
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, R.A, immunosuppression, or other
In septic arthritis of hip- surgical drainage is
Joint is opened through a small incision and
washed with normal saline.
Small drain is left in place after incision is
Suction-irrigation is continued for another 2 or 3
In knee- arthroscopic debridement and copious
In adults- repeated closed aspiration of joint
28. TOM SMITH ARTHRITIS
Septic arthritis of the hip.
Seen in infants.
Head of femur is completely destroyed by the
Transphyseal vessels are present in early
infancy before the formation of the growth
plate This may account for the frequency of
septic arthritis of the hip in the neonate
29. Clinical features
Onset is acute with rapid abscess formation.
Can be mistaken for a superfical infection.
Can present later with complaints of limp without
O/E: Affected leg is shorter and hip movements
are increased in all directions.
30. X-ray- complete absence of the head and neck of
Condition resembles DDH; complete absence of
head and neck and normally developed round
Acute surgical emergency.
Open drainage of hip joint is the most effective
method of treatment in septic arthritis of the hip.
Arthroscopic drainage can also be attempted.