The complications of septic arthritis in the elderly

An epidemiological analysis of cases of spontaneous community acquired septic arthritis in an elderly population at a university teaching hospital.

Confirmed cases of spontaneous septic arthritis in the over-65 population were studied. Patients with prosthetic joint infections were excluded from the study. Analysed data included initial presenting complaint and clinical examination, hematological and microbiological tests together with ultimate patient outcome.

There were 7 confirmed cases of spontaneous septic arthritis in the over 65 population in the past 6 months (2 hips, 5 knees). The mean age was 72.14 (range 65-82) with a mean length of stay of 49 days. Those with septic arthritis of the knee presented with swelling, pain and immobility. Hip cases presented with pain and immobility. All patients were systemically well at the time of presentation, with no other foci of infection detected after septic screening. All patients had confirmed aspirate and arthroscopic/arthrotomy infection. Staphylococcus aureus was isolated from 6 joint aspirations and Pseudomonas Aeruginosa from one patient. Complications of treatment included acute renal failure, cardio/respiratory failure, disseminated infection, and death (1 case).

Septic arthritis must be considered as a differential diagnosis in all patients with joint pain, swelling and immobility. This diagnosis is not confined to the pediatric population. A background of degenerative disease and occult presentation in the elderly may delay diagnosis. Sepsis must be considered in the elderly with joint pathology, and treatment must be initiated in a prompt and aggressive manner, to prevent sequelae.