Septic arthritis (SA) is a secondary infective disease due to joints inflammation. It often appears with mono- or oligoarticular acute arthritis that frequently leads to an emergency department (ED) visit with need for prolonged hospitalization. SA is an orthopedic emergency that can threaten both life and limb due to its potential rapid destruction of the joint with fulminant sepsis, causing significant disability within hours to days. Delayed or poor treatment of septic arthritis can lead to irreversible joint damage with consequent disability in addition there to significant mortality rate. Management includes early detection and treatment with antibiotics, joint aspiration, and consultation for orthopedic surgery as potential operative management. This review aims to summarize current evidence regarding evaluation and management of septic arthritis in emergency department, and to highlight the difficulties of diagnosing and managing SA that face the healthcare providers to help overcome those difficulties and to recommend further studies to be done regarding those problems and their solutions.