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Septic arthritis (Risk factors (Elderly, Medical conditions
(DM, CKD,…
Septic arthritis
Risk factors
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Medical conditions
(DM, CKD, joint disease e.g. RA)
Iatrogenic
(joint surgery, IA injection, prosthesis)
Drugs
(IVDU, immunosuppression)
Pathophysiology
Source can be direct injury and innoculation or haematogenous spread (UTI, pneumonia etc)
Caused by S aureus, streps, NG, gram -ves
Pyogenic infection occurs, can destroy joint <24h
with irreversible destruction and instability
Clinical
presentation
Joint pain
Onset
Usually acute, can be insidious
(especially if infected prosthesis)
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Radiation
May radiate to adjacent joint e.g. hip to knee,
knee to ankle
Associated symptoms
Fever, malaise
Hot, swollen, tender joint
Antalgic gait
Timing
Continous, progressive
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Heat, swelling,
tenderness
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Diagnosis
Examination
Joint - erythema, swelling, effusion,
warmth, tender, reduced ROM due to pain
Gait - antalgic
Investigations
Bloods
FBC, CRP (inflammation), U+E, LFTs
Blood cultures
Synovial fluid aspirate
ASAP
Appearance, gram stain, MCS,
polarised light microscopy (gout)
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Imaging
X-radiograph of joint
May show loosening/bone loss around prosthesis
Often of little help in acute situation
History
Trauma, preceeding illness
Immunocompromised
Joint disease
Management
Definitive
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Surgical
If prosthetic, ma need arthrocentresis,
lavage, debridement and replacement
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