What is septic arthritis?

Septic arthritis (or infectious arthritis) is the infection of the joints caused by bacteria or viruses. This results in the inflammation of the synovial fluid that surrounds and lubricates the joints. Normally, the synovial fluid is free from microbes, but in septic arthritis, there may be a presence of microbes.

Septic arthritis usually affects single joints and can affect individuals of all ages. The complications of septic arthritis are as follows:

  • Osteomyelitis (infection of the bone)
  • Fibrous ankylosis (stiffening of the joints due to formation of fibrous bands)
  • Sepsis (severe life-threatening infection)
  • Death

What is the treatment for septic arthritis?

Surgical drainage of the septic joint is the treatment for septic arthritis. Drainage method includes the following:

  • Needle aspiration (removing the infectious discharge via a syringe)
  • Tidal irrigation (repeated distention and irrigation of the joint with saline under local anesthesia through a needle)
  • Arthroscopy (if the arthritis is longer than seven days)
  • Arthrotomy (creating an opening in the joint that is used for drainage)

Indications for surgical drainage in patients are as follows:

  • Purulent arthritis (pus-filled arthritis)
  • Any underlying joint disease
  • Failure to respond to antibiotics and multiple aspirations
  • Septic arthritis affecting the shoulder
  • Suppressed immunity
  • Infection with an enlarged mass

Surgical drainage should be avoided in patients with bleeding disorders and those who are on anticoagulants.

How is surgical drainage performed?

Needle aspiration

  • This technique involves a needle and syringe to drain the synovial fluid. 
  • The surgeon injects the needle to drain the synovial fluid. 
  • After draining the synovial fluid, it is analyzed to identify the presence of microbes.
  •  Needle aspiration can be useful as a treatment too. 
  • This procedure is useful in draining the fluid from the ankles.

Arthroscopy

  • This technique involves inserting a special pencil-thin instrument through a key-hole incision.
  • The surgeon may also use a tool known as an arthroscope that has a light and camera to view the joints. 
  • This procedure is useful in draining the fluid from the knees, ankles and shoulders.

Arthrotomy

  • This technique involves the creation of an opening in a joint to drain the fluid. It is reserved for microbes deeply rooted in the joints. 
  • It is especially useful in draining the fluid from the shoulders and hips. 
  • Arthrotomy is the superior choice for septic arthritis of the shoulder. 

What about recovery after surgical drainage?

The patient may experience some pain after the surgery, for which the physician prescribes pain medications. The physician may also prescribe blood thinners to prevent blood clots. The patient may require crutches or a splint for support during the recovery period.

In the recovery period from a surgical drainage, the patient should perform exercises to increase the flexibility and strength of the joint.

What are the complications of surgical drainage?

The major complication of surgical drainage is infection. Clearing the infection immediately is necessary to preserve the joints. Long-standing infection can lead to joint destruction.

QUESTION

The term arthritis refers to stiffness in the joints. See Answer

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Medically Reviewed on 8/5/2020
References
"Surgical Treatment of Septic Arthritis Technique"

Medscape Medical Reference
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