Septic (Infectious) Arthritis

Septic arthritis is

an infection that occurs in a joint

the pathogen causing septic arthritis can be

- bacterial

- fungal

- viral

what accounts for about 80% of all joint infections

Staphylococcus Aureus

direct routes a joint can becomes septic

- hematogenous (blood-borne)

- direct inoculation (penetrating injury)

- direct extension of an infection or abscess in the soft tissue surrounding the joint or bone in the joint

Common involved joints in the blood-borne route: Adults

- hip

- knee

Common involved joints in the blood-borne route: Children

- elbow

- ankle

approximately 50% of children that develop hematogenous septic arthritis are

less than 3 years old

A common route of septic arthritis seen in physical therapy

Direct inoculation/penetrating injury

Direct inoculating/penetrating injuries include

- surgery

- joint infections

- joint aspirations

- fight-bite! (da pitt)

Predisposing factors for septic arthritis

- chronic corticosteroid use

- diabetes

- recent joint surgeries

- HIV

- alcoholism

- IV drug use

- Trauma

- Infection elsewhere (gonorrhea, endocarditis, strep)

what joint structures are involved in septic arthritis

any joint structure can be infected which included articular cartilage, synovium, articular capsule and ligaments

Clinical Manifestation of Septic Arthritis

- joint pain/tenderness (out of proportion)

- loss of jt ROM

- Constitutional signs and symptoms

- swelling/hot/rubor

- children will refuse to bear weight on infected jt

Septic Arthritis medical management: Imaging

MRI and plain films can provide clues to diagnosis

Septic Arthritis medical management: To determine infecting organism

joint aspirate

Bacterial septic arthritis is usually treted with

- IV antibiotics

- Corticosteroids

Bacterial Septic Arthritic sometimes is necessary for

- surgical drainage

- irrigation

Septic arthritis joint fluid

cloudy and red, normal is clear and theres a lot less

PT Implications for Septic Arthritis: Screening

Screening pts w/ trauma around joints for potential penetrating joint injuries

PT Implications for Septic Arthritis: Monitoring

Monitoring post-surgical pts for the development of signs and symptoms of infection

PT Implications for Septic Arthritis: Recognization

recognizing that gonorrhea, strep and other systemic infection can settle into a joint and produce hot swollen jts, pt presenting with this w/o injury needs to be screened very carefully

PT Implications for Septic Arthritis: Early recognition

its critical! the longer definitive treatment is delayed, the poorer the prognosis