Septic Arthritis & Osteomyelitis

Dr. Ashok J.
Septic Arthritis & Osteomyelitis - Patient Education
What is septic arthritis?
It is the infection of a joint. It affects the lining membrane of a joint called the synovium. In very young children it breaks into the joint from the bone. It occurs when inflammation and pus of the bone break into the joint. Osteomyelitis is infection of the bone.

Figure 1 Septic arthiritis of the right hip joint
Figure 1 Septic arthritis of the Right hip joint
Septic arthritis of the Right hip joint

Septic arthritis of the Right hip joint

How does it occur?
In newborns, due to weak immune system and a weak body resistance, infection spreads from other sites like boils, respiratory system, ear etc.

Hospital acquired infection occurs due to invasive procedures which involve tampering with the normal body linings e.g. when blood is drawn from the femoral vein it may cause hip joint infection. A heel puncture may cause infection of the heel bone. Infection can then spread from the bone to the adjacent joint.

What are the symptoms?
The symptoms are difficult to detect in a young baby as they do not give rise to bodily symptoms for e.g. fever. If body does not react to the infection, there may be no fever and the absence of fever may mislead doctors.
The child may be irritable or cranky. The child cry when handled moved or when nappies are changed.
There may be swelling of the joint depending on the stage of the infection. Also, the child may be reluctant to move the affected extremity (also called pseudoparalysis).
Septic Arthritis can always be suspected but never confirmed on clinical grounds. Doctors have to be very vigilant to suspect the condition.

What does your doctor do?
After clinically examining the patient, the doctor shall investigate the child. He may do some blood tests and X-RAY of the affected extremity. If there is an element of doubt, further investigations like Radioisotope scan, MRI may be done. On suspicion, aspiration of the joint may be done to check for pus. If pus is present it is sent for further testing namely- organism detection and drug sensitivity.

Is aspiration of the joint required?
Aspiration of the joint is both diagnostic and therapeutic. It works very well for superficial joints and in early stages of infection deep-seated joints e.g. hip joint. Surgery is more effective especially if pus is thick . If it is managed by aspiration, then a repeat aspiration may be required depending on the clinical sign and symptoms.

Microarthroscopy is a procedure by which a wash to the joint is given and the joint is visualized . It is usually done for knee joint. Surgery is the process by which pus is drained and if bone is infected, it is cleaned off.

How long does my child need to take antibiotics either intravenously/ orally?
For how long should the child be on an antibiotic is controversial. Intravenous antibiotics are usually given till both signs & symptoms resolve, usually for 1-2 weeks. By convention 2-4 weeks of oral Antibiotics are required for a full cure.

Will my child’s joint have to be splinted/ rested and for how long?
In uncomplicated cases, the joint is splinted for a few days. When child starts moving extremely actively, the splint or the support may be removed.

Is physiotherapy required for the joint and when?
Physiotherapy is not required until complications occur.

What are the precautions to be taken to prevent it?
Septic arthritis is difficult to prevent and the only precaution that should be taken is to make sure that your child is healthy. Also, the diagnosis of the infection is suspected when child is unwell e.g. respiratory infection, urinary tract infection. The diagnosis should never be delayed.

What are the consequences of not detecting it early?
It can be absolutely disastrous. The child may limp lifelong e.g. if the ball of the hip joint is destroyed. If the disease is fulminant, it can even lead to death. Long term, it may lead to shortening of the leg, deformation of the extremity and joint dislocation.
Hence, infection should be detected early, ideally within 3-4 days of symptom onset.
Figure 3 -Destroyed right hip joint post infection
Destroyed right hip joint post infection

What are the chances of recurrence?
The chances of recurrence are low. It can occur in a young child with involvement of multiple joints together or it may recur due to delayed resolution of infection due to improper treatment.

Which are the commonest joints involved?
Hip, Knees, shoulder and elbow in that order the commonest joints involved. For osteomyelitis, the commonest bones involved are upper femur, lower femur, upper tibia, and upper humerus in that order.

What is the treatment for osteomyelitis?
The treatment is surgery. The bone is drilled and the medullary canal is opened. The pus is then drained. The patient is given antibiotics for 4-6 weeks accordingly.
Septic osteomyelitis
Septic osteomyelitis

Septic osteomyelitis

Post osteomyelitis treatment
Post osteomyelitis treatment

Post osteomyelitis deformity of the forearm
Post osteomyelitis deformity of the forearm

Post osteomyelitis deformity of the forearm

Post osteomyelitis deformity of the forearm

Septic Arthritis & Osteomyelitis Septic Arthritis & Osteomyelitis 08/01/2015
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