{{Infobox medical condition (new)
| name            = Septic arthritis
| synonyms        = Infectious arthritis, joint infection
| image           = SepticArth2011 (cropped).jpg
| caption         = Septic arthritis as seen during [[arthroscopy]]<ref>{{cite journal|last1=Hagino|first1=Tetsuo|last2=Wako|first2=Masanori|last3=Ochiai|first3=Satoshi|title=Arthroscopic washout of the ankle for septic arthritis in a three-month-old boy|journal=Sports Medicine, Arthroscopy, Rehabilitation, Therapy & Technology|date=1 October 2011|volume=3|issue=1|doi=10.1186/1758-2555-3-21}}</ref>
| field           = [[Orthopedic surgery]]
| symptoms        = Red, hot, painful single joint<ref name=AFP2011/>
| complications   = 
| onset           = Rapid<ref name=AFP2011/>
| duration        = 
| types           = 
| causes          = [[Bacteria]], [[viruses]], [[fungi]], [[parasites]]<ref name=NORD2009/>
| risks           = [[Joint replacement|Artificial joint]], prior [[arthritis]], [[diabetes]], [[poor immune function]]<ref name=AFP2011/>
| diagnosis       = [[Joint aspiration]] with [[microbial culture|culture]]<ref name=AFP2011/>
| differential    = [[Rheumatoid arthritis]], [[Reiter’s syndrome]], [[osteoarthritis]], [[gout]]<ref name=AFP2011/><ref name=NORD2009/>
| prevention      = 
| treatment       = [[Antibiotics]], [[surgery]]<ref name=AFP2011/>
| medication      = [[Vancomycin]], [[ceftriaxone]], [[ceftazidime]]<ref name=AFP2011/>
| prognosis       = 15% risk of death (treatment), 66% risk of death (without treatment)<ref name=AFP2011/>
| frequency       = 5 per 100,000 per year<ref name=NORD2009>{{cite web|title=Arthritis, Infectious|url=https://rarediseases.org/rare-diseases/arthritis-infectious/|website=NORD (National Organization for Rare Disorders)|accessdate=19 July 2017|date=2009|deadurl=no|archiveurl=https://web.archive.org/web/20170221081703/https://rarediseases.org/rare-diseases/arthritis-infectious/|archivedate=21 February 2017|df=}}</ref>
| deaths          = 
}}
<!-- Definition and symptoms -->
'''Septic arthritis''', also known as '''joint infection''' or '''infectious arthritis''', is the invasion of a [[joint]] by an [[infectious agent]] resulting in [[arthritis|joint inflammation]].<ref name=NORD2009/> Symptoms typically include redness, heat, and pain in a single joint associated with a decreased ability to move the joint.<ref name=AFP2011>{{cite journal|last1=Horowitz|first1=DL|last2=Katzap|first2=E|last3=Horowitz|first3=S|last4=Barilla-LaBarca|first4=ML|title=Approach to septic arthritis.|journal=American Family Physician|date=15 September 2011|volume=84|issue=6|pages=653–60|pmid=21916390}}</ref> Onset is usually rapid.<ref name=AFP2011/> Other symptoms may include [[fever]], weakness, and [[headache]].<ref name=AFP2011/><ref name=NORD2009/> Occasionally more than one joint may be involved.<ref name=NORD2009/>

<!-- Cause and diagnosis -->
Causes include [[bacteria]], [[viruses]], [[fungi]], and [[parasites]].<ref name=NORD2009/> Risk factors include an [[Joint replacement|artificial joint]], prior [[arthritis]], [[diabetes]], and [[poor immune function]].<ref name=AFP2011/> Most commonly joints becomes infected via [[bacteremia|the blood]] but may also become infected via trauma or an infection around the joint.<ref name=AFP2011/> Diagnosis is generally based on [[joint aspiration|aspirating joint fluid]] and [[microbial culture|culturing]] it.<ref name=AFP2011/> [[White blood cell]]s of greater than 50,000 mm<sup>3</sup> or [[Lactic acid|lactate]] greater than 10 mmol/l in the joint fluid also makes the diagnosis likely.<ref name=Car2011>{{cite journal|last1=Carpenter|first1=CR|last2=Schuur|first2=JD|last3=Everett|first3=WW|last4=Pines|first4=JM|title=Evidence-based diagnostics: adult septic arthritis.|journal=Academic Emergency Medicine|date=August 2011|volume=18|issue=8|pages=781–96|pmid=21843213|doi=10.1111/j.1553-2712.2011.01121.x|pmc=3229263}}</ref><ref name=AFP2011/>

<!-- Treatment -->
Initial treatment typically include [[antibiotics]] such as [[vancomycin]], [[ceftriaxone]], or [[ceftazidime]].<ref name=AFP2011/> Surgery may also be done to clean out the joint.<ref name=AFP2011/> Without early treatment long term joint problems may occur.<ref name=AFP2011/> Septic arthritis occurs in about 5 people per 100,000 each year.<ref name=NORD2009/> It occurs more commonly in older people.<ref name=NORD2009/> With treatment about 15% of people die while without 66% die.<ref name=AFP2011/>

==Signs and symptoms==
Septic arthritis most commonly causes pain, swelling, and warmth at the affected joint. Therefore, those affected by septic arthritis will often refuse to use the extremity and prefer to hold the joint rigidly. [[Fever]] is also a symptom; however, it is less likely in older patients.

The most common joint affected is the knee. Hip, shoulder, wrist, or elbow joints are less commonly affected. Spine, [[Sternoclavicular joint|sternoclavicular]], and [[Sacroiliac joint|sacroiliac]] joints can also be involved; however, the most common cause of arthritis in these joints is [[Drug injection|intravenous drug use]].

Usually only one joint is effected. More than one joint can be involved if bacteria are seeded through the bloodstream.

==Cause==
Septic arthritis is most commonly caused by bacteria reaching the [[synovial membrane]] of a joint. Bacteria can enter the joint by:
* The [[Circulatory system|bloodstream]] from an infection elsewhere (most common)
* Direct penetration into the joint
* A surrounding infection in the [[bone]] or [[Tissue (biology)|tissue]] (uncommon).<ref name="AFP2011" /><ref name=":4" /><ref name=":1">{{Cite web|url=https://www.uptodate.com/contents/septic-arthritis-in-adults|title=Septic arthritis in adults|last=Goldberg|first=D.L.|last2=Sexton|first2=D.J.|date=2017|website=UpToDate|publisher=UpToDate Inc|location=Waltham, MA|archive-url=|archive-date=|dead-url=|access-date=}}</ref>
Micro-organisms in the blood may come from infections elsewhere in the body such as [[Abscess|abscesses]], [[Infection|wound infections]], [[osteomyelitis]], [[Urinary tract infection|urinary tract infections]], [[meningitis]] , or [[endocarditis]].<ref name=":1" /> Sometimes the infection comes from an unknown location. Joints with preexisting arthritis, such as [[rheumatoid arthritis]], are especially prone to bacterial arthritis seeded through the blood stream.<ref name=":1" /> In addition, some treatments for [[rheumatoid arthritis]] can also increase a patient's risk by causing an [[Immunodeficiency|immunocompromised]] state.<ref name="AFP2011" /> [[Drug injection|Intravenous drug use]] can cause endocarditis that seeds bacteria into the bloodstream and subsequently causes septic arthritis.

Bacteria can enter the joint directly from prior surgery, [[Joint injection|intraarticular injection]], [[Major trauma|trauma]], or [[Joint replacement|joint prosthesis]].<ref name=":0">{{Cite book|url=https://www.worldcat.org/oclc/893557976|title=Harrison's principles of internal medicine.|last=|first=|publisher=|others=Kasper, Dennis L.,, Fauci, Anthony S., 1940-, Hauser, Stephen L.,, Longo, Dan L. (Dan Louis), 1949-, Jameson, J. Larry,, Loscalzo, Joseph,|year=2105|isbn=9780071802161|edition=19th edition|location=New York|pages=|chapter=Infectious Arthritis|oclc=893557976}}</ref><ref name=":4">{{Cite journal|last=Shirtliff|first=Mark E.|last2=Mader|first2=Jon T.|date=2002-10-01|title=Acute Septic Arthritis|url=http://cmr.asm.org/content/15/4/527|journal=Clinical Microbiology Reviews|language=en|volume=15|issue=4|pages=527–544|doi=10.1128/cmr.15.4.527-544.2002|issn=0893-8512|pmid=12364368}}</ref><ref name=":3">{{Cite book|url=https://www.worldcat.org/oclc/950203123|title=Principles and practice of hospital medicine|last=|first=|publisher=McGraw-Hill Education|others=McKean, Sylvia C.,, Ross, John J. (John James), 1966-, Dressler, Daniel D.,, Scheurer, Danielle,|year=2017|isbn=9780071843133|edition=Second edition|location=New York|pages=|chapter=Osteomyelitis and Septic Arthritis|oclc=950203123}}</ref>

=== Risk factors ===
* Age over 80 years <ref name="AFP2011" /><ref name=":1" />
* [[Diabetes mellitus]] <ref name="AFP2011" /><ref name=":1" />
* [[Osteoarthritis]] <ref name="AFP2011" />
* [[Rheumatoid arthritis]] <ref name=":1" />
* [[Immunosuppressive drug|Immunosuppressive medication]] <ref name="AFP2011" />
* [[Drug injection|Intravenous drug abuse]] <ref name="AFP2011" />
* Recent joint surgery <ref name=":1" />
* [[Joint replacement|Hip or knee prosthesis]] and skin infection <ref name="AFP2011" /><ref name=":1" />
* [[HIV]] infection <ref name="AFP2011" /><ref name=":1" />
* Other causes of [[sepsis]] <ref name="AFP2011" />
Having more than one risk factor greatly increases risk of septic arthritis.<ref name=":1" />

=== Organisms ===
Most cases of septic arthritis involve only one organism; however, polymicrobial infections can occur, especially after large open injuries to the joint.<ref name=":3" />
* [[Staphylococcus|Staphyloccoci]]
** [[Staphylococcus aureus]] - the most common cause in most age groups. Can be caused by skin infection, previously damaged joint, prosthetic joint, or intravenous drug use.<ref name=":1" /><ref name=":3" />
** [[Staphylococcus epidermidis|coagulase-negative staphylococci]] - usually due to prosthetic joint <ref name=":0" />
* [[Streptococcus|Streptococci]] - the second most common cause <ref name=":3" /><ref name="AFP2011" />
** [[Streptococcus pyogenes]] - a common cause in children under 5 <ref name=":0" />
** [[Streptococcus pneumoniae]]
** [[Group B streptococci]] - a common cause in infants <ref name=":1" />
* [[Haemophilus influenzae]] <ref>{{cite journal|date=August 1997|title=Decline of bone and joint infections attributable to haemophilus influenzae type b|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0009-921X&volume=341&spage=128|journal=Clin. Orthop. Relat. Res.|volume=|issue=341|pages=128–33|doi=|pmid=9269165|vauthors=Bowerman SG, Green NE, Mencio GA}}<br>
{{cite journal|date=May 1998|title=Reduced incidence of septic arthritis in children by Haemophilus influenzae type-b vaccination. Implications for treatment|url=http://www.jbjs.org.uk/cgi/pmidlookup?view=long&pmid=9619939|journal=J. Bone Joint Surg. Br.|volume=80|issue=3|pages=471–3|doi=10.1302/0301-620X.80B3.8296|pmid=9619939|vauthors=Peltola H, Kallio MJ, Unkila-Kallio L}}
</ref>
* [[Gonorrhea|Neisseria gonorrhoeae]] - the most common cause of septic arthritis in young, sexually active adults.<ref name="Malik2010">{{cite journal|date=November 2010|title=Emergent evaluation of injuries to the shoulder, clavicle, and humerus|journal=Emerg Med Clin North Am|volume=28|issue=4|pages=739–63|doi=10.1016/j.emc.2010.06.006|pmid=20971390|vauthors=Malik S, Chiampas G, Leonard H}}</ref> Multiple macules or vesicles seen over the trunk are a pathognomonic feature.<ref name="Kaandorp">{{cite journal|date=August 1997|title=Incidence and sources of native and prosthetic joint infection: a community based prospective survey|url=|journal=Ann. Rheum. Dis.|volume=56|issue=8|pages=470–5|doi=10.1136/ard.56.8.470|pmc=1752430|pmid=9306869|vauthors=Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA}}<br>
{{cite journal|date=April 1999|title=Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991|url=|journal=Ann. Rheum. Dis.|volume=58|issue=4|pages=214–9|doi=10.1136/ard.58.4.214|pmc=1752863|pmid=10364899|vauthors=Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M}}</ref>
* [[Neisseria meningitidis]] <ref name=":1" /><ref name=":3" />
* [[Escherichia coli]] - in the elderly, IV drug users and the seriously ill <ref name=":1" />
* [[Pseudomonas aeruginosa]] - IV drug users or penetrating trauma through the shoe <ref name=":0" /><ref name=":3" />
* [[M. tuberculosis]], [[Salmonella]] spp. and [[Brucella]] spp. - cause septic spinal arthritis <ref name="Axford">{{cite book|title=Medicine|vauthors=O'Callaghan C, Axford JS|publisher=Blackwell Science|year=2004|isbn=0-632-05162-0|edition=2nd|location=Oxford|pages=}}</ref>
* [[Eikenella corrodens]] - human bites <ref name=":0" />
* [[Pasteurella multocida]], [[bartonella henselae]] - animal bites or scratches <ref name=":0" />
* Fungal species - [[Immunodeficiency|immunocompromised]] state <ref name=":1" />
* [[Borrelia burgdorferi|Borrelia burgodorferi]] - ticks, causes [[lyme disease]] <ref name=":1" />

==Diagnosis==
Septic arthritis should be considered whenever a person has rapid onset pain in a swollen joint, regardless of fever. One or multiple joints can be affected at the same time.<ref name=":2">{{Cite journal|last=Margaretten|first=Mary E.|last2=Kohlwes|first2=Jeffrey|last3=Moore|first3=Dan|last4=Bent|first4=Stephen|date=2007-04-04|title=Does this adult patient have septic arthritis?|journal=JAMA|volume=297|issue=13|pages=1478–1488|doi=10.1001/jama.297.13.1478|issn=1538-3598|pmid=17405973}}</ref><ref name=":0" /><ref name="AFP2011" />

The diagnosis of septic arthritis is based on physical exam and prompt [[arthrocentesis]] which yields [[synovial fluid]] from within the affected joint. This fluid should be collected before the administration of [[antibiotics]] and should be sent for [[gram stain]], [[Microbiological culture|culture]], [[White blood cell|leukocyte count]] with differential, and [[Gout|crystal studies]].<ref name=":1" /><ref name=":0" /> This can include [[NAAT]] testing for [[Neisseria gonorrhoeae|N. gonorrhoeae]] if suspected in a sexually active patient.<ref name=":3" /> 

Other studies such as blood cultures, [[white blood cell count]] with differential, [[Erythrocyte sedimentation rate|ESR]], and [[C-reactive protein|CRP]] should also be included. However, these tests are nonspecific and could be elevated due to infection elsewhere in the body. [[Serology|Serologic]] studies should be done if [[lyme disease]] is suspected.<ref name=":0" /><ref name=":3" />

In children, the [[Kocher criteria]] is used for diagnosis of septic arthritis.<ref>{{Cite journal|last=Kocher|first=Mininder S.|last2=Mandiga|first2=Rahul|last3=Murphy|first3=Jane M.|last4=Goldmann|first4=Donald|last5=Harper|first5=Marvin|last6=Sundel|first6=Robert|last7=Ecklund|first7=Kirsten|last8=Kasser|first8=James R.|date=June 2003|title=A clinical practice guideline for treatment of septic arthritis in children: efficacy in improving process of care and effect on outcome of septic arthritis of the hip|url=https://www.ncbi.nlm.nih.gov/pubmed/12783993|journal=The Journal of Bone and Joint Surgery. American Volume|volume=85-A|issue=6|pages=994–999|issn=0021-9355|pmid=12783993}}</ref>

=== Classification ===
Septic arthritis is usually caused by[[bacteria]], but may be caused by[[Virus|viral]],[[Mycobacteria|mycobacterial]], and[[Fungus|fungal]] pathogens as well.<ref name="AFP2011" />

==== Nongonoccocal Arthritis ====
These[[bacteria]]account for over 80% of septic arthritis cases and are usually[[Staphylococcus|staphyloccoci]] or [[Streptococcus|streptococci]].<ref name="AFP2011" /> It is commonly spread through the blood from an infection site elsewhere, but can be introduced directly into the joint or from surrounding tissue.<ref name=":0" />

==== Gonococcal Arthritis ====
[[Neisseria gonorrhoeae]]is a common cause of septic arthritis in sexually active patients under 40 years old.<ref name="AFP2011" /><ref name=":0" /> The bacteria is spread through the blood to the joint following sexual transmission. Other symptoms of [[disseminated gonococcal infection]] can include [[tenosynovitis]] and dermatitis.<ref name=":3" /><ref name="AFP2011" />

==== Other ====
[[Fungus|Fungal]] and [[Mycobacterium|mycobacterial]] infections are rare causes of septic arthritis and usually have a slow onset of joint symptoms.<ref name="AFP2011" />

[[Borrelia burgdorferi|Borrelia burgodorferi]], a bacteria that causes [[lyme disease]], can affect multiple joints.<ref name="AFP2011" />

Viruses such as [[rubella]], [[parvovirus B19]], [[chikungunya]], and [[HIV]] infection can also cause arthritis.<ref name=":0" />

=== Joint aspiration ===
In the [[Joint aspiration|joint fluid]], the typical white blood cell count in septic arthritis is over 50,000-100,000 cells per 10<sup>−6</sup>/l (50,000-100,000 cell/[[Cubic millimetre|mm<sup>3</sup>]]).<ref name=":5">{{Cite journal|last=Courtney|first=Philip|last2=Doherty|first2=Michael|title=Joint aspiration and injection and synovial fluid analysis|url=http://linkinghub.elsevier.com/retrieve/pii/S1521694213000120|journal=Best Practice & Research Clinical Rheumatology|volume=27|issue=2|pages=137–169|doi=10.1016/j.berh.2013.02.005}}</ref> However, septic [[synovial fluid]] can have white blood cell counts as low as a few thousand in the early stages. Therefore, differentiation of septic arthritis from other causes is not always possible based on cell counts alone.<ref name=":5" /><ref name=":1" />

The [[Gram stain]] can rule in the diagnosis of septic arthritis, however, cannot exclude it.<ref name=":1" />

[[Synovial fluid|Synovial]] fluid [[Microbiological culture|cultures]] are positive in over 90% of nongonoccocal arthritis; however, it is possible for the culture to be negative if the patient received antibiotics prior to the joint aspiration.<ref name=":1" /><ref name=":0" /> Cultures are usually negative in gonoccocal arthritis or if [[Fastidious organism|fastidious organisms]] are involved.<ref name=":0" /><ref name=":1" />

If the culture is negative or if a gonococcal cause is suspected, [[NAAT]] testing of the synovial fluid should be done.<ref name=":0" />

Positive crystal studies do not rule out septic arthritis. Crystal induced arthritis such as [[gout]] can occur at the same time as septic arthritis.<ref name="AFP2011" />  

A lactate level in the synovial fluid of greater than 10 mmol/l makes the diagnosis very likely.<ref name="Car2011" />

===Blood tests===
Laboratory testing includes [[white blood cell count]], [[Erythrocyte sedimentation rate|ESR]], and [[C-reactive protein|CRP]]. These values are usually elevated in those with septic arthritis; however, these can be elevated by other infections or [[Inflammation|inflammatory conditions]] and are, therefore, [[Specificity and sensitivity|nonspecific]].<ref name="AFP2011" /><ref name=":0" /> [[Procalcitonin]] may be more useful than CRP.<ref>{{cite journal|last1=Zhao|first1=J|last2=Zhang|first2=S|last3=Zhang|first3=L|last4=Dong|first4=X|last5=Li|first5=J|last6=Wang|first6=Y|last7=Yao|first7=Y|date=August 2017|title=Serum procalcitonin levels as a diagnostic marker for septic arthritis: A meta-analysis.|journal=The American journal of emergency medicine|volume=35|issue=8|pages=1166–1171|doi=10.1016/j.ajem.2017.06.014|pmid=28623003}}</ref>

[[Blood culture|Blood cultures]] can be positive in up to half of patients with septic arthritis.<ref name="AFP2011" /><ref name=":1" />

===Imaging===
Imaging such as [[x-ray]], [[CT scan|CT]],[[Magnetic resonance imaging|MRI]], or[[ultrasound]]are[[Sensitivity and specificity|nonspecific]]. They can help determine areas of inflammation but cannot confirm septic arthritis.<ref name=":4" />

When septic arthritis is suspected,[[X-ray|x-rays]]should generally be taken.<ref name=":1" /> This is used to assess for involvement of surrounding structures such as bone and also for comparison purposes when future x-rays are taken.<ref name=":1" />While x-rays may not be helpful early in the diagnosis/treatment, they may show subtle increase in joint space and tissue swelling.<ref name=":0" /> Later findings include joint space narrowing due to destruction of the joint.<ref name=":4" />

[[Ultrasound]]can be done and is effective at detecting joint effusions.<ref name=":4" />

[[CT scan|CT]]and[[Magnetic resonance imaging|MRI]] are not required for diagnosis but can be used if diagnosis is unclear or in joints that are hard to examine (ie.[[Sacroiliac joint|sacroiliac]]or[[Hip|hip joints]]). They can can help assess for inflammation/infection in or about the joint (ie.[[Osteomyelitis|osteomyeltis]]).<ref name=":1" /><ref name=":4" />

=== Differential diagnosis ===
* Crystal induced arthritis such as [[gout]] or [[Calcium pyrophosphate dihydrate crystal deposition disease|pseudogout]] <ref name=":1" /><ref name=":3" />
* [[Inflammatory arthritis]] <ref name=":1" /><ref name=":3" />
** [[Rheumatoid arthritis]]
** Seronegative spondyloarthropathy such as [[ankylosing spondylitis]] or [[reactive arthritis]]
* Traumatic arthritis due to [[hemarthrosis]], [[Bone fracture|fracture]], or [[foreign body]] <ref name=":1" />
* [[Osteoarthritis]] <ref name=":1" /><ref name=":3" />

== Treatment ==
Treatment is usually with [[intravenous]] [[Antibiotic|antibiotics]], [[analgesia]] and [[Debridement|washout]] and/or [[Arthrocentesis|aspiration]] of the joint.<ref name=":1" /><ref name=":0" /> Draining the pus from the joint is important and can be done either by needle ([[arthrocentesis]]) or opening the joint surgically ([[arthrotomy]]).<ref name="AFP2011" />

[[Empiric antibiotics]] for suspected bacteria should be started. This should be based on [[gram stain]] of the [[synovial fluid]] as well as other clinical findings.<ref name="AFP2011" /><ref name=":0" /> General guidelines are as follows:
* Gram positive [[Coccus|cocci]] - [[vancomycin]] <ref name="AFP2011" /><ref name=":1" />
* Gram negative [[Coccus|cocci]] - [[Ceftriaxone]] <ref name="AFP2011" />
* Gram negative [[bacilli]] - [[Ceftriaxone|Ceftrioxone]], [[cefotaxime]], or [[ceftazidime]] <ref name=":1" />
* Gram stain negative and immunocompetent - [[vancomycin]] <ref name=":1" />
* Gram stain negative and [[Immunodeficiency|immunocompromised]] - [[vancomycin]] + third generation [[Cephalosporin|cephalosphorin]] <ref name=":1" />
* [[Drug injection|IV drug]] use (possible pseudomonas aeruginosa) - [[ceftazidime]] +/- an [[aminoglycoside]] <ref name=":1" /><ref name=":0" />
Once [[Microbiological culture|cultures]] are available, antibiotics can be changed to target the specific organism.<ref name=":1" /><ref name=":0" />

After a good response to intravenous antibiotics, patients can be switched to oral antibiotics. The duration of oral antibiotics varies, but is generally for 1-4 weeks depending on the offending organism.<ref name="AFP2011" /><ref name=":0" /><ref name=":1" />

In infection of a [[Joint replacement|prosthetic joint]], a [[biofilm]] is often created on the surface of the prosthesis which is resistant to antibiotics.<ref>{{Cite web|url=https://www.uptodate.com/contents/prosthetic-joint-infection-epidemiology-clinical-manifestations-and-diagnosis|title=Prosthetic joint infection: Epidemiology, clinical manifestations, and diagnosis|last=Berbari|first=Elie|last2=Baddour|first2=L. M.|date=2017|website=UpToDate|publisher=UpToDate Inc|location=Waltham, MA|archive-url=|archive-date=|dead-url=|access-date=}}</ref> [[Debridement|Surgical debridement]]  is usually indicated in these cases.<ref name=":6">{{Cite web|url=https://www.uptodate.com/contents/prosthetic-joint-infection-treatment|title=Prosthetic joint infection: Treatment|last=Barbari|first=Elie|last2=Baddour|first2=L. M.|date=2017|website=UpToDate|publisher=UpToDate, Inc|location=Waltham, MA|archive-url=|archive-date=|dead-url=|access-date=}}</ref><ref name="AFP2011" /> A replacement prosthesis is usually not inserted at the time of removal to allow antibiotics to clear infection of the region.<ref name=":4" /><ref name=":6" /> Patients that cannot have surgery may try long-term antibiotic therapy in order to suppress the infection.<ref name=":4" />

Close follow up with [[Physical examination|physical exam]] & labs must be done to make sure patient is no longer feverish, pain has resolved, has improved [[range of motion]], and lab values are normalized.<ref name=":1" /><ref name="AFP2011" />

== Outcomes ==
Risk of permanent impairment of the joint varies greatly.<ref name=":1" /> This usually depends on how quickly treatment is started after symptoms occur as longer lasting infections cause more destruction to the joint. The involved organism, age, preexisting arthritis, and other [[Comorbidity|comorbidities]] can also increase this risk.<ref name=":4" /> Gonococcal arthritis generally does not cause long term impairment.<ref name=":0" /><ref name=":1" /><ref name=":4" />

[[Mortality rate|Mortality]] rates generally range from 10-20%.<ref name=":4" /> These rates increase depending on the offending organism, older age, and comorbidities such as [[rheumatoid arthritis]] <ref name=":1" /><ref name=":3" /><ref name=":4" />

==References==
{{Reflist}}

== External links ==
{{Medical resources
|  DiseasesDB     = 29523 
|  ICD10          = {{ICD10|M|00||m|00}}-{{ICD10|M|03||m|00}} 
|  ICD9           = {{ICD9|711.0}} 
|  ICDO           =  
|  OMIM           =  
|  MedlinePlus    = 000430 
|  eMedicineSubj  = med 
|  eMedicineTopic = 3394 
|  eMedicine_mult = {{EMedicine2|orthoped|438|}} 
|  MeshID         = D001170
}}
{{Diseases of the musculoskeletal system and connective tissue}}
{{Arthritis in children}}

{{DEFAULTSORT:Septic Arthritis}}
[[Category:Arthritis]]
[[Category:Infectious arthropathies]]
[[Category:Medical emergencies]]
[[Category:RTT]]
[[Category:RTTEM]]