infectious%20arthritis
INFECTIOUS ARTHRITIS
The classical presentation of infectious arthritis is acute onset of pain, warmth and swelling of a single joint.
The range of motion is usually decreased.
The knee is the most commonly affected but any joint may be involved.
Fever and chills may be present.
More than 1 joint may be involved in patients with pre-existing joint disease, other inflammatory conditions or severe sepsis, and in some patients infected with certain pathogens eg N gonorrheae, N meningitidis and Salmonella spp.
Infectious arthritis must always be a part of the differential diagnosis in a patient with an acute monoarthritis. 

Surgical Intervention

  • Joint drainage is done to decompress the joint and remove pus, and allows debridement as well as specimens to be obtained for biopsy and repeat culture
    • The cornerstone for the treatment of non-gonococcal infectious arthritis
  • Joint drainage may be done via:
    • Needle aspiration
      • Closed-needle aspiration can be considered in patients who are medically unfit to undergo arthrotomy or arthroscopy
      • Usually done for peripheral joints
      • Repeat aspiration daily may be needed for 7-10 days
    • Arthroscopy
      • May be used as an alternative to open surgery
      • Mostly done on the knee, shoulder and wrist
      • Associated with shorter hospital stay
      • Provide better visualization of the joint space for prognostic purposes
    • Open surgical drainage/Arthrotomy
      • Done when full drainage cannot be achieved thru needle aspiration or when there is absence of improvement even with multiple needle aspirations
      • Mostly done for the hips, shoulders and prosthetic joints
  • Delayed joint drainage may lead to permanent joint damage resulting from increased intra-articular pressure
  • All patients with suspected infectious arthritis of a prosthetic joint should be referred to an orthopedic surgeon
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