Septic Arthritis of the Knee
The knee is the commonest joint in the body to be affected by septic arthritis. Septic arthritis of the knee is usually caused by Staphylococcus aureus, but there is a wide spectrum of causative organisms, and Gram-negative organisms are implicated in 10–
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Simon D.S. Newman and Charles E.R. Gibbons
Abstract
The knee is the commonest joint in the body to be affected by septic arthritis. Septic arthritis of the knee is usually caused by Staphylococcus aureus, but there is a wide spectrum of causative organisms, and Gram-negative organisms are implicated in 10–20 % of cases. The gold standard for diagnosis is joint fluid culture, but microscopy and Gram staining can be negative in up to 50 % of cases, and newer assays such as α-defensin and blood tests such as procalcitonin have potential to improve the diagnostic yield in the acute situation. Septic arthritis is serious with a mortality of over 10 % and permanent joint damage in 40 %. Recognition of symptoms, proper interpretation of investigations and prompt treatment are mandatory to achieve a good outcome. Keywords
Knee • Septic arthritis • Diagnosis • Treatment
12.1
Introduction
The hot, swollen knee is a common presentation to healthcare professionals in primary and secondary care. Whilst there is a wide differential diagnosis (Table 12.1), arguably the most serious is septic arthritis. The incidence of septic arthritis is 4–10 per 100,000 per year in Western Europe S.D.S. Newman (*) • C.E.R. Gibbons Department of Trauma and Orthopaedic Surgery, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK e-mail: [email protected]; [email protected]
with the incidence rising to 30–100 per 100,000 in those with rheumatoid arthritis [1–3]. The knee, with its extensive synovial lining facilitating microbial ingress, is the commonest joint in the adult body to be affected with in excess of 50 % of confirmed cases and in children, it is affected second only to the hip joint [4]. Septic arthritis is the invasion of a joint by a microorganism that generates a purulent response. In the majority of cases the responsible organism is a bacterium and acute bacterial septic arthritis will form the focus of this chapter, however other pathogens including viruses and fungi may also directly infect joints. Reactive arthritis
© Springer International Publishing Switzerland 2017 E.C. Rodríguez-Merchán, A.D. Liddle (eds.), Joint Preservation in the Adult Knee, DOI 10.1007/978-3-319-41808-7_12
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S.D.S. Newman and C.E.R. Gibbons
144 Table 12.1 Differential diagnosis for the acute swollen knee Crystal arthritides Gout Pseudogout Inflammatory arthritides Rheumatoid arthritis Psoriatic arthritis Reactive arthritis including Reiter’s disease Ankylosing spondylitis Enteropathic associated arthropathies Lupus Familial mediterranean fever Other Osteoarthritis Avascular necrosis Ochronosis
Trauma Soft tissue injury Spontaneous haemarthrosis Fracture
Infection Acute bacterial septic arthritis Viral septic arthritis
Fungal septic arthritis Mycobacterial septic arthritis
Lyme disease Acute rheumatic fever Tumour/Metaplasia Pigmented villous nodular synovitis Synovial chondromatosis Sarcoma Hypertrophic pulmonary osteoarthropathy
is a separate condition whereby infection elsewhere in the body, com
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