eMedicine Specialties > Infectious Diseases > Bone and Joint Infections

Septic Arthritis: Follow-up

Author: John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
Contributor Information and Disclosures

Updated: Aug 25, 2008

Follow-up

Further Inpatient Care

  • Usually, immobilization of the infected joint to control pain is not necessary after the first few days.
  • Initial physical therapy consists of maintaining the joint in its functional position and providing passive range-of-motion exercises. The joint should bear no weight until the clinical signs and symptoms of synovitis have resolved. Aggressive physical therapy is often required to achieve maximum therapy benefit.
  • Overall, the mean length of hospitalization for septic arthritis is 11.5 days. However, outpatient antibiotic therapy in stable patients can significantly reduce hospital stays.

Further Outpatient Care

  • Perform physical therapy as indicated.

Inpatient & Outpatient Medications

  • Oral antibiotics are usually used in treating gonococcal joint infections. Antibiotics have a role in suppressing associated chronic osteomyelitis and chronically infected prosthetic material that cannot be removed for various reasons.

Deterrence/Prevention

  • Strictly adhere to sterile procedures whenever the joint space is invaded (eg, in aspiration or arthroscopic procedures).
  • Antibiotic prophylaxis with an antistaphylococcal antibiotic has been demonstrated to reduce wound infections in joint replacement surgery. Polymethylmethacrylate cement impregnated with antibiotics may decrease perioperative infections.
  • Using antibiotic prophylaxis on the same theoretical basis as that for cardiac valvular disease has been advocated. In short, whenever a sustained bacteremia may be encountered, consider using a prophylactic regimen similar to those of the American Heart Association. The implanted hardware most likely is at greatest risk of bacteremia infection within a few months of placement. The risk probably decreases as a pseudocapsule evolves. During this time, prophylaxis is probably most beneficial.
  • Treat any infection promptly to lessen the chance of bloodstream invasion.
  • Decreasing the incidence of underlying infections best prevents reactive arthritis.

Complications

  • Dysfunctional joints, osteomyelitis, and sepsis are complications.

Prognosis

  • Fifty percent of adults with septic arthritis have significant sequelae of decreased range of motion or chronic pain after infection.4
  • Predictors of poor outcome in suppurative arthritis include the following:
    • Age older than 60 years
    • Infection of the hip or shoulder joints
    • Underlying rheumatoid arthritis
    • Positive findings on synovial fluid cultures after 7 days of appropriate therapy
    • Delay of 7 days or more in instituting therapy
  • Thirty percent of cases of reactive arthritis may become chronic.

Patient Education

  • Instruct patients with a prosthetic joint in place to recognize early signs of joint infection and, more importantly, to recognize bacterial infections in other parts of their bodies to prevent associated bacteremias.
  • For excellent patient education resources, visit eMedicine's Arthritis Center and Bites and Stings Center. Also, see eMedicine's patient education articles Knee Pain and Ticks.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize an infected joint and to promptly institute appropriate therapy poses a significant malpractice risk.
 


More on Septic Arthritis

Overview: Septic Arthritis
Differential Diagnoses & Workup: Septic Arthritis
Treatment & Medication: Septic Arthritis
Follow-up: Septic Arthritis
References
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References

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Further Reading

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Keywords

septic arthritis, infectious arthritis, infective arthritis, suppurative arthritis, reactive arthritis, inflammatory arthritis, bacterial septic arthritides, acute bacterial arthritis, bacterial septic arthritis, bacterial arthritis, viral arthritis, Neisseria gonorrhoeae, N gonorrhoeae, Staphylococcus aureus, S aureus, Streptococcus viridans, S viridans, Streptococcus pneumoniae, S pneumoniae, group B streptococci, crystalline arthritis, Lyme disease, Lyme arthritis, prosthetic joint infections, PJI, rheumatoid arthritis

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Contributor Information and Disclosures

Author

John L Brusch, MD, FACP, Assistant Professor of Medicine, Harvard Medical School; Consulting Staff, Department of Medicine and Infectious Disease Service, Cambridge Health Alliance
John L Brusch, MD, FACP is a member of the following medical societies: American College of Physicians and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Maria D Mileno, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, Brown University
Maria D Mileno, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, International Society of Travel Medicine, and Sigma Xi
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Aaron Glatt, MD, Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, New Island Hospital
Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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