Septic Arthritis, Osteomyelitis & Implant Infection
Recognise musculoskeletal infection and coordinate sampling, treatment and source control.
Quick revision ↓ Medical Dictionary
01The hot joint
Acute joint pain, swelling and restricted movement can indicate septic arthritis. Fever may be absent, especially in vulnerable patients. Assess systemic illness and risk factors, including recent procedures, immunosuppression and prosthetic joints. Do not assume that a known inflammatory condition explains every new hot joint.
02Sampling and urgency
Arrange urgent specialist assessment and appropriate aspiration or cultures. In a stable patient, useful samples are usually obtained before antibiotics where feasible; sepsis or instability requires prompt treatment without unsafe delay. Synovial crystals do not exclude coexisting infection, and results must be interpreted together.
03Bone infection
Osteomyelitis can present with focal pain, reduced limb use or systemic symptoms, while chronic infection may be less dramatic. Early radiographs may be normal. Select blood tests and imaging according to the clinical question and involve the relevant surgical and infection teams when suspicion persists.
04Implants and biofilm
Infection involving a prosthesis or fixation device can require a different strategy from uncomplicated soft-tissue infection. Persistent wound drainage, pain or loosening warrants specialist assessment. Unplanned antibiotics in a stable patient can complicate sampling, so coordinate the diagnostic plan while prioritising urgent treatment when clinically necessary.
05Treatment and follow-up
Management combines appropriate antimicrobials with drainage or debridement when indicated. Review organism results, drug tolerance, wound condition and function. Rehabilitation must fit source control and structural stability. Persistent or recurrent symptoms require reassessment rather than repeatedly treating presumed superficial inflammation.
High-Yield Revision
- A hot joint needs infection considered even without fever.
- Crystals do not exclude simultaneous infection.
- Normal early radiographs do not exclude osteomyelitis.
Common Pitfalls
- Delaying sepsis treatment for perfect sampling.
- Treating persistent implant drainage as a routine dressing problem.
References & Further Reading
Read the relevant guideline sections alongside these original clinical teaching cases. Local pathways, available services and individual patient factors determine care.
Reference review: 28 September 2026. Consult current local protocols for prescribing, procedures and escalation.