Infection in orthopaedics

Infection in bone and joints is a potentially very serious condition. Prompt recognition, appropriate referral and expeditious treatment are essential in order to avoid serious long term sequelae. Acute septic arthritis is an orthopaedic emergency which requires removal of the pus from the joint and intravenous antibiotics. Acute osteomyelitis, if diagnosed early, will usually settle with a course of antibiotics alone (these should be started immediately after obtaining blood cultures). If the diagnosis is delayed, the patient will require surgical drainage. Chronic osteomyelitis is a variable condition unless. If it is causing minimal morbidity it can be treated non-operatively, more commonly, however, it requires surgical treatment to drain the pus and remove the areas of dead bone. In some cases of implant related sepsis, it is possible to retain the prosthesis but in the majority, the implant has to be revised. In general, in patients with orthopaedic infections, wherever possible, it is preferable to obtain a microbiological diagnosis before initiating antibiotic therapy as appropriately targeted antibiotic therapy increases the chances of eradication of infection.