Septic arthritis

Introduction

Define/describe the condition

Anatomy

Describe the pertinent anatomy and provide links to relevant pages

Pathogeneis

Describe the biologic basis of the disorder or the mechanism of injury

Natural History

Describe the natural history,epidemiology and prognosis

Patient History and Physical Findings

Presence of fever: 57% sensitivity

Joint Pain: 85% sensitivity (95%CI 78-90)

Joint Swelling: 78% Sensitivity (95% CI 71-85)

Imaging and Diagnostic Studies

Gram Stain: Sensitivity only 29% - 50%

Culture: Sensitivity may only be 82%

Synovial Cell Count: The best diagnostic tool while awaiting culture results . Table data taken from Margaretten et al

Value	Likelihood Ratio	95% CI
WBC's < 25,000	0.32	0.23-0.43
WBC's > 25,000	2.9	2.5-3.4
WBC's > 50,000	7.7	5.7-11.0
WBC's > 100,000	28	12.0-66.0
PMN's < 90%	0.34	0.25-0.47
PMN's >90%	3.4	2.8-4.2

Peripheral White Blood Cell Count: Sensitivity: 90%; Specificity: 36%

ESR: Sensitivity: 95%; Specificity 29%

CRP: Sensitivity: 77%; Specificity: 53%

Differential Diagnosis

Treatment

Include:
Medical therapy
Nonoperative treatment
Operative treatment - include links to pages with detailed surgical techniques
Indications and contraindications

Pearls and Pitfalls

Tips and problems to avoid

Postoperative Care

Include immediate postoperative care and rehabilitation

Outcome

Include functional and prosthetic survivorship data as applicable

Complications

Include overview of complications

Selected References

http://www.ncbi.nlm.nih.gov/pubmed/17405973