Septic Arthritis Management: Current Guidelines
Volume 8 | Issue 1 | January-April 2022 | Page: 08-13 | Gaurav Gupta, Easwar T. Ramani, Gaurav Garg, Maulin Shah
DOI-10.13107/ijpo.2022.v08i01.128
Authors: Gaurav Gupta MS Ortho. [1, 2], Easwar T. Ramani MS Ortho. [3, 4 ], Gaurav Garg MS Ortho. [5], Maulin Shah MS Ortho. [6]
[1] Department of Paediatric Orthopaedics, Asian Hospital, Faridabad, UP, India.
[2] Department of Orthopaedics, Child Ortho Clinic, Faridabad & Delhi, India.
[3] Department of Paediatric Orthopaedics, Baby Memorial Hospital, Kozhikode, Kerala, India.
[4] Department of Paediatric Orthopaedics and Spine Surgery, Palakkad District Cooperative & Research Centre, Palakkad, Kerala, India.
[5] Department of Paediatric Orthopaedics, Excelcare Hospital, Jaipur, India.
[6] Department of Paediatric Orthopaedics, Orthokid Clinic, Ahmedabad, Gujarat, India.
Address of Correspondence
Dr. Maulin Shah,
Consultant Paediatric Orthopaedic Surgeon, Orthokid Clinic, Ahmedabad, Gujarat, India.
E-mail: maulinmshah@gmail.com
Abstract
Septic arthritis is an orthopaedic emergency that is more commonly seen in infants and young children. Release of proteolytic enzymes leads to permanent destruction of intra-articular cartilage and subchondral bone as early as 72 hours after onset. Hip and knee are the most commonly involved joints. Staphylococcus aureus is the most common causative organism across all paediatric age groups. Recently, there is a significant increase in incidence of Klebsiella and Pseudomonas, especially in neonates. Sensitivity patterns of causative organisms are also changing with increasing resistance to empirical antibiotics, requiring the use of higher antibiotics.
The detection of septic arthritis in neonates is challenging. The physician has to rely on indirect signs and maintain a high index of suspicion. C-reactive protein (CRP) along with difficulty in weight bearing have a better predictive value in diagnosis. Ultrasonography (USG) is a useful tool for quick screening of a joint and to detect effusion. Many recent studies have suggested percutaneous drainage/aspiration as an equally effective modality to manage septic joints, thus avoiding the morbidity of open arthrotomy and the risks of general anaesthesia. Lack of response to minimally invasive methods warrant an open approach. Antero-lateral arthrotomy is preferred over the posterior approach to avoid iatrogenic damage to the blood supply of the femoral head. Arthroscopic lavage of the septic joint is also becoming popular. The choice of empiric antibiotic treatment should be based on age, vaccination status and underlying co-morbidities. There is growing evidence in literature for short-course intravenous (IV) therapy. Delayed diagnosis, sickle cell disease, and infection caused by certain strains of methicillin-resistant staphylococcus aureus (MRSA) are predispose to orthopaedic sequelae.
Keywords: Septic Arthritis, Arthrotomy, Osteomyelitis.
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| How to Cite this Article: Gupta G, Ramani ET, Garg G, Shah M | Septic Arthritis Management: Current Guidelines | International Journal of Paediatric Orthopaedics | January-April 2022; 8(1): 08-13. |
