Orthopedic infections and other complications

Stephen Y. Liang, Michael C. Bond, Michael K. Abraham

Research output: Chapter in Book/Report/Conference proceedingChapter


Septic arthritis Key facts • Infection occurs primarily through hematogenous seeding of the joint (bacteremia) • Contiguous soft-tissue infection or direct inoculation of the joint (e.g., penetrating trauma, recent arthrocentesis or intra-articular injection) may also play a part, albeit to a lesser extent • Risk factors include age, diabetes mellitus, rheumatoid arthritis, joint surgery, prosthetic joint (hip or knee), skin infection, intravenous drug use, and alcoholism • Staphylococcus aureus and streptococcus are the primary infecting organisms seen in adults, although immunocompromised patients may also be at risk for Gram-negative infection • Disseminated Neisseria gonorrhoeae infection can present as septic arthritis and should be considered in sexually active adults Clinical presentation • Joint pain that is worse with range of motion is a primary complaint, most commonly involving the knee or hip • Fever is often present • Examination of the affected joint may reveal: • Joint effusion with erythema, warmth, and tenderness • Painful or limited range of motion • Overlying cellulitis or pustules (seen with disseminated Neisseria gonorrhoeae infection[DGI]) • Multiple joint involvement is occasionally seen, particularly with DGI or sepsis • Symptoms and examination findings may be minimal in the setting of immunosuppression Diagnostic testing • Definitive diagnosis rests upon arthrocentesis of the affected joint, preferably before antibiotics are given

Original languageEnglish
Title of host publicationOrthopedic Emergencies
Subtitle of host publicationExpert Management for the Emergency Physician
PublisherCambridge University Press
Number of pages13
ISBN (Electronic)9781139199001
ISBN (Print)9781107696617
StatePublished - Jan 1 2013

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    Liang, S. Y., Bond, M. C., & Abraham, M. K. (2013). Orthopedic infections and other complications. In Orthopedic Emergencies: Expert Management for the Emergency Physician (Vol. 9781107696617, pp. 178-190). Cambridge University Press. https://doi.org/10.1017/CBO9781139199001.009