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Septic arthritis
- 4. Causes : •Bacterial (staphylococcus aureus, E.coli, proteus and streptococcus) • viral • mycobacterial • fungal
- 5. Predisposing factors: Rheumatoid arthritis Intravenous drug abuse Immunosuppressive drug therapy AIDS DM Old age >80 years Chronic disorder
- 7. Hematogenous spread Most common form of spread Usually affect people with underlying medical problem Direct inoculation • May result from penetrating trauma • Introduction of organism during diagnostic and surgical procedure e.g. arthroscopy and intra-articular injection Direct spread from adjacent focal infection
- 10. Clinical manifestations Fever Acute severe pain Swelling of the joint Tenderness Warmth Limited joint mobility
- 11. Imaging: X-RAY: Early stage –soft tissue swelling, loss of tissue planes, widening of joint space and slight sublaxation due to fluid in the joint. Gas may be seen with E.coli infection Late stage – narrowing and irregularity of joint space Periosteal reaction, bone destruction and sequestrum formation
- 13. Lateral view ofankle joint, exaggerated soft tissue swelling, decreased joint space with sclerotic ends of bone
- 14. Underlying bony erosionsand reduced joint space in talus AP view
- 15. Joint space decreased osteophytes AP view
- 16. Head of femurdeformed and necrosed,loss of joint space LEFT SIDE
- 17. Ultrasonography Morereliable in revealing a joint effusion in early cases. Widening of space between capsule and bone of >2mm indicates effusion. Echo free transient synovitis Positively echogenic septic arthritis Ultrasound can detect joint-swelling.
- 18. Being a non-ionizing, easily available, non-invasive and relatively cheap modality, Ultrasound should be first line of investigation in a suspected case of infective arthritis.
- 21. computed tomography: Early findings: Soft tissue swelling Joint space widening
- 22. Late findings(2-3w): Joint space narrowing Blurring of fat planes Increased density of fatty marrow Periosteal reaction Cortical erosion or destruction Intraosseous gas
- 23. CT Scan demonstratingsoft tissue oedema localised to the right sternoclavicular joint (A) and appearances of an associated joint effusion, erosion and destruction of sternal end
- 24. CT of lefthip joint The dd included septic arthritis/osteomyelitis joint
- 25. Sagittal CT scanof C-spine shows a bone erosion of the anterior portion of odontoid process of C2 (arrow)
- 26. MRI findings: •Synovial enhancement • Perisynovial edema and joint effusion. • Single or multiple radiolucent abscesses • Assessment of the extent of tissue affected
- 27. Significance of CTand MRI: • Cross-sectional imaging modalities such as CT and MRI are now considered standard in the diagnosis of septic arthritis because they have, • Excellent spatial resolution • Early detection • Assessment of the extent of tissue affected Although expensive, they are sensitive and specific.
- 32. Nuclear medicine imaging: Nuclear medicine imaging can detect septic arthritis 10 to 14 days before changes are visible on plain radiographs. Highly Sensitive but Nonspecific Inexpensive Focal hyper perfusion Focal hyperemia Focal bone uptake
- 33. Complications: bonedestruction and dislocation of the joint (especially hip) Cartilage destruction May lead to either fibrosis or bony ankylosis In adult partial destruction of the joint will result in secondary osteoarthritis Growth disturbance Presenting as either localized deformity or shortening of the bone
- 34.
Editor's Notes
- #25 .