[Infections of non-prosthetically treated joints]

Septic arthritis is a common orthopedic emergency. Immediate establishment of the diagnosis and administration of an adequate therapy is paramount in minimizing morbidity and mortality in this severe condition.

The aim of the present review was to evaluate the existing evidence in order to give an overview on current best practice in diagnostics and treatment of septic arthritis in adults and children.

Joint infections result from either hematogenous spread or direct inoculation of bacteria into the joint, mostly iatrogenically. Predisposing risk factors include recent orthopedic joint surgery, i. v. drug abuse, pre-existing inflammatory and degenerative joint diseases and old age. Although pathogens differ in different populations and age groups Staphylococcus aureus is the single most frequently isolated causative organism, followed by streptococci. Although diagnosis is based on an integration of medical patient history, clinical and laboratory findings and imaging studies, joint fluid analysis remains the mainstay in establishing a valid diagnosis. The range of differential diagnostics is broad and includes non-infectious inflammatory joint diseases, such as gout or reactive arthritis. Once a diagnosis has been established treatment should be started immediately. Treatment is based on adequate antibiotic therapy and joint drainage until dryness. There is a paucity of studies on the optimal antibiotic regimen, route of application and duration of therapy. Moreover, no high-quality studies exist on the optimal mode of joint drainage. While superiority has yet to be shown, operative treatment in terms of arthroscopic lavage must be considered the standard of care in Germany. Finally, despite promising results in children, the role of corticosteroids as an adjunct to antibiotic treatment in adults has yet to be clarified.