Orthopedic management of septic arthritis

The goals in the management of septic arthritis are joint decompression, joint sterilization, and preservation of joint function. Opinions on how these goals are best accomplished vary among medical disciplines. Although the literature supports both serial aspirations and arthrotomy as viable ways to treat pyarthrosis, most orthopedic surgeons prefer arthrotomy. There are advantages to surgical management, including more complete decompression, especially in infections characterized by thick, purulent fluid or loculations; a lower intra-articular bacterial count after lavage; the opportunity to perform a synovectomy; and no delay in cases that may be unresponsive to simple aspiration and antibiotics. Rehabilitation of the septic joint is paramount in preserving range-of-motion and cartilage protection. Although splinting and immobilization are necessary in treating acute infections, early range of motion is paramount in preserving long-term joint function.