Treatment of Septic Joint Based on Age : Wheeless' Textbook of Orthopaedics

- Treatment Based on Age:

- less than 3 months
- up to 60-100% of neonates w/ septic arthritis have adjacent osteomyelitis.
- septic arthritis is both more common and more often associated w/ metaphyseal osteomyelitis in neonates than in older children;
- may occur from transphyseal blood vessels (see epiphyseal vessels), which disappear by age six months, and from synovial reflections over
metaphyseal bone, which decrease with age;
- in the older children, only the metaphysis of the shoulder, hip, radial head and ankle remains intracapsular;
- from 6 mo to 2 yrs
- there should first be a search for evidence of other infections because a large percentage (50%) of children w/ hematogenous osteomyelitis
and septic arthritis have evidence of an associated infection;
- concomitant meningitis may occur in up to 20% of patients w/ septic arthritis due to H. influenzae;
- cerebrospinal examination should be considered and antibiotics that can cross the blood-brain barrier should be chosen;
- greater than 2 yrs
- references:
- Acute septic arthritis in infancy and childhood. 10 years' experience.
- Management of septic arthritis in children.
- Septic arthritis in children.
- Septic arthritis in infants and children: a review of 117 cases.
- 5 to 15 years:
- diff dx: acute rheumatic fever
- adults:
- staph aereus
- streptococcus
- adults with septic arthritis due to streptococcus should be worked up for multiple myeloma