Infection in Bone and Joints - Pt 2

Question 1

What is septic arthritis?

Answer 1

Infection of the joint, most commonly caused by bacteria

Question 2

What is the route of infection for acute septic arthritis?

Answer 2

Haematogenous, eruption of bone abscess, and direct invasion - penetrating wound, intra-articular injury and arthroscopy

Question 3

Where is the focus for route of infection in acute septic arthritis?

Answer 3

Metaphyseal septic focus

Question 4

What are the common organisms of acute septic arthritis?

Answer 4

Staphylococcus aureus, haemophilus influenza, streptococcus pyogenes and E. coli

Question 5

Describe the pathology of acute septic arthritis

Answer 5

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin and cellular enzyme
Complete destruction of articular cartilage

Question 6

What is the outcomes of acute septic arthritis?

Answer 6

Complete recovery, partial loss of articular cartilage and subsequent OA, or fibrous or bony ankylosis

Question 7

What is the symptoms of acute septic arthritis in neonates?

Answer 7

Picture of septicaemia - irritability, resistance to movement and ill

Question 8

What is the symptoms of acute septic arthritis in child/ adult?

Answer 8

Acute pain in single large joint, reluctant to move joint, swelling, not erythema, increased temp. and pulse, and increased tenderness

Question 9

What investigations are used for acute septic arthritis?

Answer 9

FBC, WBC, ESR, CRP and blood cultures
X-ray
US, MRI and aspiration

Question 10

Describe infected joint replacement and acute septic arthritis

Answer 10

Common cause of septic arthritis in adults
Rare but significant
Changing picture of organisms but staph epidermidis/ aureus is still most common

Question 11

What are the different diagnosis for acute septic arthritis?

Answer 11

Acute osteomyelitis, trauma, irritable joint, haemophilia, rheumatic fever, gout and Gaucher’s disease

Question 12

What is the treatment for acute septic arthritis?

Answer 12

General supportive measures
Antibiotics for 3-4 weeks
Surgical drainage and lavage - emergency (open or arthroscopic lavage)
Infected joint replacement - one stage revision, two stage revision and antibiotics

Question 13

What is the classification for tuberculosis in bone and joint?

Answer 13

Extra-articular (epiphyseal/ bones with haemodynamic marrow)
Intra-articular (large joints)
Vertebral body

Question 14

Can tuberculosis in bone and joint have multiple lesions?

Answer 14

1/3 of patients have multiple lesions

Question 15

What are the clinical features of tuberculosis in bone and joints?

Answer 15

Insidious onset and general ill health
Contact with TB
Pain (esp. at night), swelling and loss of weight
Low grade pyrexia
Decrease ROM
Ankylosis
Deformity

Question 16

Describe the pathology for tuberculosis

Answer 16

Primary complex - in lung or in gut
Secondary spread
Tuberculosis granuloma
Role of nutrition/ other disease - HIV AIDS

Question 17

What does spinal tuberculosis present as?

Answer 17

Little pain
Presents with abscess or kyphosis

Question 18

What are features to look for when diagnosing tuberculosis?

Answer 18

Long history, involvement of single joint, marked thickening of synovium, marked muscle wasting, and periarticular osteoporosis

Question 19

What investigations are involved when diagnosing tuberculosis?

Answer 19

FBC, ESR, Mantoux test, sputum/ urine culture, X-ray (soft tissue swelling, periarticular osteopenia, and articular space narrowing), and Joint aspiration and biopsy

Question 20

What are the differential diagnosis of tuberculosis?

Answer 20

Transient synovitis
Monoarticular RA
Haemorrhagic arthritis
Pyogenic arthritis

Question 21

What is the treatment for tuberculosis?

Answer 21

Chemotherapy
Initial - Rifampicin, isoniazid and ethambutol 8 weeks
Then - Rifampicin and isoniazid 6-12 months
Rest and splint
Operative drainage/ fusion - rare