- Discussion:
- orthopaedic infection menu
- general orders and treatment
- synovial fluid exam; (cell count and crystals)
- gram stain: (gram negative bacilli, gram negative cocci: (NG), gram positive bacilli:, gram positive bacilli)
- references:
- Gram staining in the diagnosis of acute septic arthritis.
- How sensitive is the synovial fluid white blood cell count in diagnosing septic arthritis?
- Does the presence of crystal arthritis rule out septic arthritis?
- differential diagnosis (also consder Brucella melitensis, Borrelia burgdorferi and Treponema pallidum)
- painful knee--an unusual cause secondary to pseudomonas septic arthritis of the hip.
- septic until proven otherwise: approach to and treatment of the septic joint in adult patients.
- medical considerations:
- consider the need for a cardiac echo (eval for endocarditis), labs for immunosuppression (HIV, Hep B)
- Treatment Based on Age: - less than 3 months, from 6 mo to 2 yrs, greater than 2 yrs
- Treatment Based on Location: (open joint injuries, septic knee:, pediatric septic hip:)
- Antibiotic Treatment Based on Organism:
- IV antibiotic menu (criteria for PO ATB's: )
- Anaerobic Infections:
- Peptostreptococcus magnus, Bacteroides fragilis, Fusobacterium, Porphyromonas, Actinobacillus, Eikenella and proprionobacter acnes;
- uncommon cause of septic arthritis (in over 80% of cases, the infection occurred after surgery or trauma, and in patients receiving steroids)
- references:
- Septic arthritis of the knee due to Prevotella loescheii following tooth extraction
- Microbiology and management of joint and bone infections due to anaerobic bacteria.
- Gram-Positive Anaerobic Cocci
- Concomitant septic and gouty arthritis--an analysis of 30 cases.
- Niseria gonococcus
- most common organism causing septic arthritis in young adults;
- look for skin lesions;
- unlike most forms of septic arthritis, GC does not necessarily require surgical washout, and and usually responds to IV antibiotics alone.
- references:
- Antibiotic concentrations in septic joint effusions. Nelson JD: N Engl J Med 1971;284:349.
- Etiology and medical management of acute suppurative bone and joint infections in pediatric patients. J Pediatr Orthop 1982; 2:313. Jackson MA, Nelson JD:
- Benefits and risks of sequential parenteral--oral cephalosporin therapy for suppurative bone and joint infections.
- The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis.
- Septic arthritis in the elderly.
- The effect of antibiotics on the destruction of cartilage in experimental infectious arthritis.
- Staphylococcal septic arthritis: antibiotic and nonsteroidal anti-inflammatory drug treatment in a rabbit model.
- Experimental septic arthritis in rabbits treated by a combination of antibiotic and steroid drugs.
- Surgical Drainage and Lavage:
- references:
- Lavage of septic joints in rabbits: effects of chondrolysis.
- Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint.
- Results of treatment of septic knee arthritis: a retrospective series of 40 cases.
- Arthroscopic drainage in septic arthritides of the knee: a multicenter study.
- Arthroscopic treatment of septic joints: prognostic factors.
- Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy.
- Arthroscopic management of septic arthritis: stages of infection and results.
- Arthroscopic therapy of septic arthritis. Surgical technique and results
- Septic arthritis: Arthroscopic management with local antibiotic treatment.
- Septic arthritis: current diagnostic and therapeutic algorithm.
- Management of septic arthritis: a systematic review.
- Tidal irrigation in septic arthritis of the knee: a potential alternative to surgical drainage.
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Alternatives to Total Knee Replacement: Autologous Hamstring Resurfacing Arthroplasty
