Local soft tissue dissemination of large joint septic arthritis: A report of two cases

Septic arthritis (SA) is a surgical emergency that can result in joint destruction and systemic sepsis. Local soft tissue dissemination of native joint SA leading to necrotising fasciitis (NF) is a rare but devastating complication associated with poorer outcomes.

We present two adult patients with poorly controlled diabetes who developed SA complicated by NF-one affecting the knee and posterior leg, the other the shoulder and anterior arm. Both required multiple joint washouts, serial wound debridements, intensive care unit (ICU) admission, and prolonged intravenous antibiotics. One patient sustained extensive soft tissue loss necessitating coverage with a biodegradable temporising matrix (BTM) followed by split-thickness skin grafting.

These cases highlight the clinical course of this rare but severe complication and emphasise the importance of early diagnosis, initiation of broad-spectrum intravenous antibiotics, and timely surgical intervention. We also outline a practical diagnostic and management framework, including antimicrobial selection post-arthrocentesis, the role of pre-operative imaging, and the rationale for selecting arthroscopic versus open joint debridement.

SA complicated by NF is a life- and limb-threatening condition that presents numerous diagnostic and therapeutic challenges. Early recognition and a multidisciplinary approach incorporating empirical antibiotics, targeted imaging, and prompt surgical management are essential to optimise outcomes.