Diagnosis and Management of the Septic Joint

Abstract

Pyarthrosis presenting in the ankle or smaller joints of the foot may arise from hematogenous spread of infection, contiguous bone or wound infection, or direct contamination from trauma. While isolated joint sepsis from a hematogenous source is more classically observed in the ankle, joints of the foot can be contaminated by an adjacent ulcer communicating with the joint. Early diagnosis and immediate treatment is important in minimizing potentially devastating local and systemic sequelae associated with this infectious process. Diagnostic criteria is often not absolute and relies in part on clinical suspicion of the physician. Ankle sepsis typically demands immediate intervention consisting of empiric intravenous antibiotic administration and joint lavage. While lavage can be achieved with serial arthrocentesis, we advocate for arthroscopic irrigation and debridement for ankle joint sepsis. The extent of debridement and number of subsequent procedures typically necessary is often contingent on the intraoperative appearance of joint destruction. Low-grade joint sepsis may require a single arthroscopic lavage procedure with minimal synovectomy while an advanced disease process typically necessitates multiple arthroscopic irrigations with extensive synovectomy. An inadequate response to empiric antibiotics and surgical intervention may signal concomitant pathology such as adjacent joint sepsis or osteomyelitis that is not sufficiently being addressed. Sepsis of smaller joints in the foot typically requires open irrigation and debridement often in conjunction with local amputation procedures for effective resection of the infectious nidus. Early identification and prompt intervention is crucial in effectively managing the patient with joint sepsis of the foot or ankle.