Evaluation and Management of Septic Arthritis and its Mimics in the Emergency Department

Abstract

Septic arthritis is a dangerous medical condition associated with significant morbidity and mortality. However, the differential diagnosis can be broad with conditions that mimic this disease and require different evaluation and treatment. This narrative review presents the emergency medicine evaluation and management, as well as important medical conditions that may mimic this disease. Septic arthritis commonly presents with monoarticular joint pain with erythema, warmth, swelling, and pain on palpation and movement. Fever is present in many patients, though most are low grade. Blood testing and imaging may assist with the diagnosis, but the gold standard is joint aspiration. Management includes intravenous antibiotics and orthopedic surgery consult for operative management vs. serial aspirations. Clinicians should consider mimics, such as abscess, avascular necrosis, cellulitis, crystal-induced arthropathies, Lyme disease, malignancy, osteomyelitis, reactive arthritis, rheumatoid arthritis, and transient synovitis. While monoarticular arthritis can be due to septic arthritis, other medical and surgical conditions present similarly and require different management. It is essential for the emergency clinician to be aware how to diagnose and treat these mimics.

Two-stage total hip arthroplasty for primary advanced septic arthritis of the hip in adults: comparison of debridement versus femoral head resection with spacer implantation

“…Staphylococcus aureus accounted for 57.14%. In the joint with pus, the positive rate of bacterial culture in synovial fluid is about 80% [18,1]. However in our study, the positive rate of bacterial culture of synovium fluid was 25%.…”

Two-stage total hip arthroplasty for primary advanced septic arthritis of the hip in adults: comparison of debridement versus femoral head resection with spacer implantation

“…In general, the rate of false negatives is high in the bacterial culture. For example, a previous report has reviewed 133 articles, which summarized the majority of positive rate of bacterial culture in synovial fluid is almost 40%-50% [18]. Our positive culture rate is about 25% (5 out of 20 in the present series) in the intra-operative diagnosis of bacterial culture.…”

Point‐of‐care hip ultrasound leads to expedited results in emergency department patients with suspected septic arthritis

“…Previous work has highlighted the importance of early diagnosis and treatment in order to reduce the risk of joint damage and poor long-term function. 16 Vispo Seara et al found that early diagnosis and intervention in septic arthritis increased the chance of long-term favorable functional outcomes. 25 Yanmis et al performed an evaluation of arthroscopic irrigation and debridement on cases of knee SA and found that delay in arthroscopic treatment resulted in poor functional outcomes.…”

“…14,15 Prompt diagnosis and intervention has been demonstrated to be a factor in reducing the risk of joint damage and poor functional outcomes. 16,17 Progression of disease in SA can be rapid and untreated disease can lead to irreversible damage to the bony articular surface. 17,18 Furthermore, delayed therapy can lead to a longer treatment course needed to eradicate the joint infection.…”