Septic arthritis

Dr. Mehzabin Ahmed

 The clinical features suggestive
of inflammation
Symptoms
• Fever
• Pain
• Swelling of the right hip joint
• Refusal to walk/ bear weight
Signs
• Restricted joint movement
• Skin- hot tender & swollen over the affected joint
The hugely swollen thigh of a child suggesting that pus may have burst
out of the hip joint, or through the periosteum of the femur
Why the hip joint is flexed, abducted
and externally rotated at rest
• When the hip joint is extended the anterior
joint capsule is stretched producing pain.
• In the above position this stretching is
avoided and the joint space is maximum so
the fluid in the space is redistributed within
the cavity and thus reduces the tension on
the capsule.
 Arthrotomy
• It is a Surgicalprocedure by which fluid
collected in the joint space is drained
• It is done immediately to remove the inflammatory
exudate to:
• 1) reduce the bacterial load
• 2) relieve the pressure on the joint produced by the
accumulated fluid
• 3) for diagnostic purposes- to identify the cause.
 Synovial fluid findings
• Increased WBC count (150,000/ml)- the fluid is
due to an inflammatory process
• Differential count- Neutrophilia (90%)- the
inflammation is acute in nature and is due to a
bacterial infection
• Decreased glucose concentration, though the
blood glucose is normal- the bacteria use up the
glucose to multiply and the neutrophils also use it
up to provide energy for phagocytosis
• Culture- Staphyloccus aureus- the agent causing
the infection.
 Hematological findings
• Increased total leucocyte count (15,000
cells/ml)- indicates an acute infection due to
a bacteria
• Increased ESR (45mm/1st hr)- indicates
acute inflammation- the acute phase
reactant proteins and CRP increase and coat
the RBC which reduces the charge on it and
the RBC pile up and settle quickly
 Immobilization of the hip
• To prevent the movement to reduce the pain
and also allow time for healing
Early passive range of movement
• To prevent contractures and joint stiffness
 Etiopathogenesis
• infection spreads from other sites
like boils, respiratory system, ear
or from a local osteomyelitic focus
etc.
• The organisms gain entry in to the blood
stream and get seeded into the joint and
cause arthritis.
 Complications
If left untreated the infection may become chronic
and the child may:
• Limp forever: the growth plate may get affected and
may cause limb shortening
• The tissues may undergo extensive necrosis and the
pus may then drain to the surface through a tract or
sinus
• The sinus tract in a long standing case may develop
squamous cell carcinoma
• Amyloidosis: the deposition of an abnormal protein at
the site of a chronic inflammation may occur
Destruction of the joint in a long standing case of septic arthritis