Muhammad Shabir.
Acute Septic Arthritis and its management.
J Postgrad Med Inst Jan ;18(2):269-74.

Objective: To know about the most common organism causing acute septic arthritis. To discuss the most effective antibiotic and best method of treatment of such patients. Material and Methods: This study was conducted in the Department of Orthopaedic at Postgraduate Medical Institute/Lady Reading Hospital, Peshawar, from 1St March 1996 to 28th February 1997. The study was carried out, on 40 patients. The causative organism and management of acute septic arthritis is discussed. Patients were evaluated and culture sensitivity of synovial fluid was done. Antibiotics were administered on the basis of culture sensitivity for 2-4 weeks. All the septic joints were drained either through arthrotomy or by aspiration/irrigation. Follow up was done for 6-12 weeks. Results: Hematogenous septic arthritis was more common and the highest incidence was found in children. Males were more commonly affected, than females. Previous treatment records of the patients showed that most of them were given antibiotics without culture/sensitivity. The disease is common in poor class. Most of the patients were having fever, pain, swelling and restriction of movements. In majority of cases septic arthritis was mono-articular. Hip was the most commonly affected joint, which also has the worst prognosis. TLC, DLC and ESR were found raised in majority of the patients. Staphylococcus aureus was the commonest organism and needed arthrotomy for good outcome. Second commonest organism was Streptococcus, which can even be treated with aspiration and irrigation, satisfactorily. First generation cephalosporin, ampicillin - cloxacillin, ampicillin - clavulonic acid combination and second-generation cephalosporins were the most effective antibiotics. Conclusion: From this study we concluded that early diagnosis and proper treatment of septic arthritis decreases its morbidity. Method of intervention makes little difference if the pre-intervention period is less than five day, except in deep joints.

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