Talk:Septic arthritis

Permission
Discussion and verification of permission is archived at Talk:Jumper's Knee. Melchoir 23:42, 17 April 2006 (UTC)

My
My mother is recovering from this condition. It took nine weeks to diagnose and this included seven weeks in a busy general hospital. Due to her age, 71, it seems the consultant and the medical teams involved were fixated on discovering typical age related deterioration of the joint despite assurances that she was very fit and able bodied and accustomed to 12 mile walks. Blood anomalies indicating an infection e.g. high but fluctuating white blood cell counts caused them to be confused and indecisive. During the first two weeks of the condition, before hospitalisation, a radiographer announced signs of an infected joint. The GP however, later declared that the radiographer must have said inflammation and prescribed Volterol to reduce inflammation and co-codamol to reduce pain. The patient experienced no relief and had a nauseous reaction to the drugs. For seven weeks in hospital the only drugs administered were painkillers including frequent doses of morphine. No antibiotics were administered and the doctors refused to administer antibiotics for an unlocated and unidentified infection when requested by the family.

An operation on her hip finally revealed that the entire tissue structure of the joint had been destroyed. The top of the femur and the acetabulum had also been eaten away and considerable softening of bone structure had taken place. The area was debrided, washed and a surgical spacer loaded with antibiotics was inserted into the femur. The infecting organism was eventually identified as Staphylococcus Aureus. Fortunately the strain, in my mother's case, is responsive to amoxycillin and fuscidic acid.

The key diagnostic feature of this condition is sudden onset of pain in a joint that has no history of problems. If the affected joint is a hip excruciating pain is felt in the groin. The pain is extreme when weight is put on the joint. The patient is quickly reduced to limping and then immobility. The correct procedure for diagnosing a suspected septic joint is to draw off some synovial fluid and to examine it. The fluid may be cloudy or streaked with pus. The fluid may be clear but in any case a sample should be cultured. Although my mother's joint was aspirated early after her admission to hospital the surgeon announced that it had yielded no information. Given the speed of the results, it seems that no attempt was made to produce a culture from the sample. Cultures should also be made from urine, faeces and mucus. To the best of my knowledge this approach was ignored in my mother's case.

Another feature of this illness is its difficulty to detect using standard x-ray, CT scanning, and ultrasound techniques. Damage to the joint structure only appears in x-ray images 10-14 days after the onset of the illness. It seems that destruction of cartilage and capsule can occur in 2-3 days once the infection is established. Treatment should proceed immediately with a general antibiotic administered intravenously and draining of the infected joint. When the precise nature of the infecting organism is established a specific battery of antibiotics can be prescribed.

Septic arthritis, also called infectious arthritis, among other names, is a medical emergency. Left unchecked the condition can bring about toxic shock and death. In my mother's case 9 weeks of extreme pain and uncertainty has left her demoralised, confused, frightened and very weak. She is now receiving massive amounts of intravenous and oral antibiotics. The course of post-operative treatment may demand six weeks in hospital receiving intravenous antibiotics and another 4 weeks of oral antibiotics. The spacer, designed to hold her femur in position and maintain structure in her limb, is intensely uncomfortable. Eventually it will be removed and replaced with an artificial hip.

The whole episode has caused unnecessary loss of a hitherto healthy hip and a great deal of distress for her family. Our family has a long history of failed medical diagnoses with unpleasant consequences. The problem for older people ill with this particular condition is that it is most common in children and younger people and thus may not be quickly identified. Boys are particularly common sufferers because they more commonly experience trauma to joints through bruising or actual puncture, most commonly of the knee joint. Infection can also take place by introduction of bacteria by the bloodstream into an otherwise healthy joint. Some cases are ascribed to infection entering the bloodstream following dental treatment. In this case there was no trauma and no recent dental procedure. The origin of the infection is unknown.


 * Do you mind if I archive this case history? It is a good example of septic arthritis, but hardly worth keeping in an encyclopedia word for word. JFW | T@lk  09:01, 6 Mar 2005 (UTC)

Diagnosis
JAMA - does this patient have septic arthritis? JFW | T@lk  20:37, 5 April 2007 (UTC)

the jama article is excellent and should be included in the front page of this article. thanks for it! —Preceding unsigned comment added by 210.4.36.56 (talk) 04:01, 4 December 2007 (UTC)

Prognosis
There is no discussion of prognosis or course of disease. This is a major omission as it is essential to understand that without successful treatment, total destruction of joint cartilage can result. —Preceding unsigned comment added by 71.141.238.140 (talk) 07:38, 26 April 2009 (UTC)