Pathophysiology

  • Haematogenous spread of microorganism to joint space is more common than direct inoculation
  • Microbiology:
    • Staph Aureus is the most common causative organism overall
    • In young, sexually active adults, non-traumatic septic arthritis is most commonly caused by Neisseria Gonorrhoea
  • The most commonly joint is the knee

   

Clinical features

  • A single red, hot, swollen joint
  • Severe pain - very limited ROM, including any passive ROM
  • Unable to weight bear if lower limbs 
  • Pyrexia and SIRS

  

Investigations

  • Joint aspiration for MCS
  • Blood cultures 

  

Management

  • 1st Line: 
    • Flucloxacillin – total course 4-6 weeks
    • Penicillin allergy: Clindamycin
  • Alternatives:
    • If MSRA suspected - vancomycin (or teicoplanin)
    • If gonococcal arthritis (or gram negative) suspected - cefotaxime
  • Plus – needle decompression +/- lavage