6 Treatment of the Septic Native Joint

Abstract

A septic native joint can be a debilitating condition that is associated with significant morbidity and mortality. Traditionally, a septic native joint was considered one of the few surgical emergencies in orthopaedics, as a delay in diagnosis and treatment can result in joint destruction and loss of joint mobility and even mortality. While prompt diagnosis is crucial, diagnosis can be challenging, as it can be difficult to differentiate between a septic native joint from crystalline arthropathy, and rheumatological and osteoarthritis flares. Diagnosis of a septic joint relies on clinical findings, serological test, synovial aspiration, and culture results. Traditionally, a synovial fluid white blood cell cutoff of 50,000 cells/mm3 is often used; however, it is important to note that infectious arthritis may frequently occur in patients with lower cell counts who are immunosuppressed or are infected with a less virulent organism. The mainstay of treatment for a septic joint is appropriate antibiotic therapy and surgical treatment. This chapter will focus only on native septic joint rather than periprosthetic joint infection, or a joint infection in the presence of a prostheses.