Septic arthritis in patients with sickle-cell disease

The presenting features, modes of treatment and sequelae of septic arthritis of 50 joints in 31 Nigerians with sickle-cell disease were studied prospectively over a 66-month period. Most patients were in the second or first decade of life. Males predominated, and the hip was the commonest site of involvement. Infection was polyarticular in 39% and was associated with osteomyelitis in 84%. Most presented with a long history of local disease. The remainder were toxic and desperately ill patients in whom arthritis occurred later. Gram-negative infection predominated, and the commonest organism was Salmonella. Treatment was conservative in most cases, and arthrotomy was performed in only 12 joints. No deaths resulted, but severe complications occurred in 76%, apparently due to delay in diagnosis, severity of illness and a high incidence of hip-joint infection.