Septic arthritis

Question 1

What is septic arthritis? Important?

Answer 1

Septic arthritis refers to infection inside a joint. This can occur at any age, but is most common in children under 4 years. Infection in a joint is an emergency, as the infection can quickly begin to destroy the joint and cause serious systemic illness. Septic arthritis has a mortality around 10%. Therefore, early recognition and management is essential.

Question 2

What causes septic arthritis?

Answer 2

Septic arthritis is a common and important complication of joint replacement. It occurs in around 1% of straight forward hip or knee replacements. This percentage is higher in revision surgery.

Question 3

Presentation septic arthritis?

Answer 3

Septic arthritis usually only affects a single joint. This is often a knee or hip. It presents with a rapid onset of:

Hot, red, swollen and painful joint
Refusing to weight bear
Stiffness and reduced range of motion
Systemic symptoms such as fever, lethargy and sepsis

Septic arthritis can be subtle in young children, so always consider it as a differential when a child is presenting with joint problems.

Question 4

Which bacteria cause septic arthritis?

Answer 4

Staphylococcus aureus is the most common causative organism.

Other bacteria:

Neisseria gonorrhoea (gonococcus) in sexually active teenagers
Group A streptococcus (Streptococcus pyogenes)
Haemophilus influenza
Escherichia coli (E. coli)

Question 5

Differential diagnosis septic arthritis?

Answer 5

Differential Diagnosis

Transient sinovitis
Perthes disease
Slipped upper femoral epiphysis
Juvenile idiopathic arthritis

Question 6

Management septic arthritis?

Answer 6

Have a low threshold for treating a patient for septic arthritis until it has been excluded with examination of the joint fluid. Be particularly cautious with immunosuppressed patients.

Patients with suspected septic arthritis require admission to hospital and involvement of the orthopaedic team.

The joint should be aspirated prior to giving antibiotics where possible. Send the sample for gram staining, crystal microscopy, culture and antibiotic sensitivities. The joint fluid may be purulent (full of pus). The gram stain will come back quite quickly and may give a clue about the organism. The full culture will take longer.

Empirical IV antibiotics should be given until the microbial sensitivities are known. Antibiotics are usually continued for 3 to 6 weeks in total when septic arthritis is confirmed. The choice of antibiotic depends on the local guidelines.

Patients may require surgical drainage and washout of the joint to clear the infection in severe cases.

Question 7

What is transient synovitis?

Answer 7

Transient synovitis is sometimes referred to as irritable hip. It is caused by temporary (transient) irritation and inflammation in the synovial membrane of the joint (synovitis). It is the most common cause of hip pain in children aged 3 – 10 years. It is often associated with a recent viral upper respiratory tract infection.

Children with transient synovitis typically do not have a fever. Children with joint pain and a fever need urgent management for septic arthritis.