Clinical features

Clinical features

Most patients present after an acute or subacute history with a single hot, swollen, painful joint. In children, there is often a history of recent minor trauma. The joint is held immobile in the ‘position of comfort’, with ‘pseudoparalysis’ in neonates. Sidney Ringer , 1835–1910, Professor of Clinical Medicine, University College Hospital, London, UK. /uni25CF /uni25CF - /uni25CF /uni25CF /uni25CF - /uni25CF /uni25CF ) is There is severe pain if any attempt is made to move the a ff ected joint actively or passively . In children and adults, the knee joint is most frequently a ff ected, whereas in neonates it is the hip. Fever and other systemic signs are usually present, but their absence does not rule out the diagnosis. Fever is absent in about one-third of cases.

Extremes of age Underlying joint abnormality, especially rheumatoid arthritis Immunocompromise (e.g. diabetes mellitus, HIV infection, immunosuppressive therapy) Joint instrumentation (e.g. steroid injection, arthroscopy) Intravenous drug abuse Indwelling central venous catheter Bacteraemia (especially Staphylococcus aureus ) HIV, human immunode /f_i ciency virus.

Clinical features

PJIs may present early (within 3 months of surgery), in a delayed manner (3–24 months from surgery) or late (after 2 /uni00A0 years). /uni25CF Early infections are acquired at surgery and are usually caused by virulent organisms (e.g. S. aureus ). They present with a discharging wound, cellulitis, pain, inflammation and swelling. /uni25CF Delayed infections are more characteristically due to low-virulence organisms (e.g. coagulase-negative staphylo cocci or cutibacteria). André Gächter , contemporary , Swiss orthopaedic surgeon. . The - /uni25CF Late infections are more likely to present with an indo - lent clinical syndrome of joint discomfort or mechanical dysfunction (‘start-up’ symptoms are particularly charac - teristic), with or without a discharging sinus. Late presen - tations are usually due to haematogenous infection of a pre viously uninfected joint, from bacteraemia. The source may indicate the microbiology (e.g. pneumococci from re - spiratory origin, Salmonella spp. from the gut, Escherichia coli from the urinary tract).

(b) Figure 43.4 (a) Septic arthritis of the hip in a person who injects drugs. This was untreated for several weeks, resulting in destruction of the joint surface. (b) The same hip after 9 months without treatment. The proximal femur and acetabulum have been grossly eroded by infection.

Clinical features

Most patients present after an acute or subacute history with a single hot, swollen, painful joint. In children, there is often a history of recent minor trauma. The joint is held immobile in the ‘position of comfort’, with ‘pseudoparalysis’ in neonates. Sidney Ringer , 1835–1910, Professor of Clinical Medicine, University College Hospital, London, UK. /uni25CF /uni25CF - /uni25CF /uni25CF /uni25CF - /uni25CF /uni25CF ) is There is severe pain if any attempt is made to move the a ff ected joint actively or passively . In children and adults, the knee joint is most frequently a ff ected, whereas in neonates it is the hip. Fever and other systemic signs are usually present, but their absence does not rule out the diagnosis. Fever is absent in about one-third of cases.

Extremes of age Underlying joint abnormality, especially rheumatoid arthritis Immunocompromise (e.g. diabetes mellitus, HIV infection, immunosuppressive therapy) Joint instrumentation (e.g. steroid injection, arthroscopy) Intravenous drug abuse Indwelling central venous catheter Bacteraemia (especially Staphylococcus aureus ) HIV, human immunode /f_i ciency virus.

Clinical features

PJIs may present early (within 3 months of surgery), in a delayed manner (3–24 months from surgery) or late (after 2 /uni00A0 years). /uni25CF Early infections are acquired at surgery and are usually caused by virulent organisms (e.g. S. aureus ). They present with a discharging wound, cellulitis, pain, inflammation and swelling. /uni25CF Delayed infections are more characteristically due to low-virulence organisms (e.g. coagulase-negative staphylo cocci or cutibacteria). André Gächter , contemporary , Swiss orthopaedic surgeon. . The - /uni25CF Late infections are more likely to present with an indo - lent clinical syndrome of joint discomfort or mechanical dysfunction (‘start-up’ symptoms are particularly charac - teristic), with or without a discharging sinus. Late presen - tations are usually due to haematogenous infection of a pre viously uninfected joint, from bacteraemia. The source may indicate the microbiology (e.g. pneumococci from re - spiratory origin, Salmonella spp. from the gut, Escherichia coli from the urinary tract).

(b) Figure 43.4 (a) Septic arthritis of the hip in a person who injects drugs. This was untreated for several weeks, resulting in destruction of the joint surface. (b) The same hip after 9 months without treatment. The proximal femur and acetabulum have been grossly eroded by infection.

Clinical features

Most patients present after an acute or subacute history with a single hot, swollen, painful joint. In children, there is often a history of recent minor trauma. The joint is held immobile in the ‘position of comfort’, with ‘pseudoparalysis’ in neonates. Sidney Ringer , 1835–1910, Professor of Clinical Medicine, University College Hospital, London, UK. /uni25CF /uni25CF - /uni25CF /uni25CF /uni25CF - /uni25CF /uni25CF ) is There is severe pain if any attempt is made to move the a ff ected joint actively or passively . In children and adults, the knee joint is most frequently a ff ected, whereas in neonates it is the hip. Fever and other systemic signs are usually present, but their absence does not rule out the diagnosis. Fever is absent in about one-third of cases.

Extremes of age Underlying joint abnormality, especially rheumatoid arthritis Immunocompromise (e.g. diabetes mellitus, HIV infection, immunosuppressive therapy) Joint instrumentation (e.g. steroid injection, arthroscopy) Intravenous drug abuse Indwelling central venous catheter Bacteraemia (especially Staphylococcus aureus ) HIV, human immunode /f_i ciency virus.

Clinical features

PJIs may present early (within 3 months of surgery), in a delayed manner (3–24 months from surgery) or late (after 2 /uni00A0 years). /uni25CF Early infections are acquired at surgery and are usually caused by virulent organisms (e.g. S. aureus ). They present with a discharging wound, cellulitis, pain, inflammation and swelling. /uni25CF Delayed infections are more characteristically due to low-virulence organisms (e.g. coagulase-negative staphylo cocci or cutibacteria). André Gächter , contemporary , Swiss orthopaedic surgeon. . The - /uni25CF Late infections are more likely to present with an indo - lent clinical syndrome of joint discomfort or mechanical dysfunction (‘start-up’ symptoms are particularly charac - teristic), with or without a discharging sinus. Late presen - tations are usually due to haematogenous infection of a pre viously uninfected joint, from bacteraemia. The source may indicate the microbiology (e.g. pneumococci from re - spiratory origin, Salmonella spp. from the gut, Escherichia coli from the urinary tract).

(b) Figure 43.4 (a) Septic arthritis of the hip in a person who injects drugs. This was untreated for several weeks, resulting in destruction of the joint surface. (b) The same hip after 9 months without treatment. The proximal femur and acetabulum have been grossly eroded by infection.