Native septic arthritis. Diagnostic and treatment principles

Evaldas Šivickas1, Karolina Staškevičiūtė1, Mantas Giedraitis2, Linas Zeniauskas2, Alfredas Smailys2, Justinas Stučinskas2

1 Lithuanian University of Health Sciences, Academy of Medicine, Kaunas, Lithuania

2 Department of Orthopaedics and traumatology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania


Introduction: Native septic arthritis is a complex joint infection that requires urgent diagnosis and adequate treatment. Although the disease is not common, it is associated with high patient suffering and high treatment costs.

Aim: to review and analyze scientific publications that describe the methods of diagnosis and treatment of native septic arthritis.

Methods: Scientific articles were searched in the PubMed database by keywords: “Native septic arthritis, infection, treatment of septic arthritis”. The aim of the study was also met by the inclusion of 29 scientific publications describing native septic arthritis or related topics.

Results: Diagnostic arthrocentesis of the affected joint should be performed if native septic arthritis is suspected. The diagnosis of infection is confirmed if the synovial fluid leukocyte count is > 20,000 / μl or the polymorphonuclear cell percentage is > 90% or the synovial fluid culture is positive. Imaging is needed to determine the stage of the lesions and to select appropriate treatment tactics. Blood tests may show an inflammatory response or an existing infection in the body, but are not specific. Treatment includes antibiotic therapy and surgery (arthroscopic lavage, arthrotomy, and open debridement or repeated fluid aspiration of small joints).

Conclusions: The diagnosis of septic arthritis is based on clinical symptoms, joint punctate and microbiological examination. Timely and accurate diagnosis results in effective treatment consisting of antibiotic therapy and surgical intervention.

Keywords: Native septic arthritis, infection, arthrocentesis, treatment of septic arthritis