NOTES

NOTES
BONE & JOINT INFECTIONS

GENERALLY, WHAT ARE THEY?

PATHOLOGY & CAUSES DIAGNOSIS
▪ Bacterial invasion and destruction of bone DIAGNOSTIC IMAGING
and joint cartilage
MRI
▪ Caused by bacteria
▪ Detect bone infections
▫ E.g. Staphylococcus aureus (S. aureus),
Mycobacterium tuberculosis (M. CT scan, X-ray
tuberculosis), Pseudomonas aeruginosa ▪ Detect fractures
(P. aeruginosa)

LAB RESULTS
RISK FACTORS
▪ Blood tests
▪ Trauma/open fractures, diabetes/
▪ Needle aspiration: pathogen detection
atherosclerosis, orthopedic implants,
existing infection etc.
TREATMENT
COMPLICATIONS
▪ Chronic infections MEDICATIONS
▪ Bone fractures ▪ Before identifying pathogen → general
▪ Loss of mobility antibiotics
▪ Dissemination of infection ▪ Known pathogen → specific antibiotics

SURGERY
SIGNS & SYMPTOMS ▪ Surgical cleaning
▪ Pain → individual avoids using infected
joint

Systemic
▪ Fever, chills, weakness, headache

Local
▪ Swollen, painful, warm

OSMOSIS.ORG 587
 OSTEOMYELITIS
osms.it/osteomyelitis
▪ Cortical loss
PATHOLOGY & CAUSES ▪ Contrast enhancement of abscess rim
▪ Bacterial infection (S. aureus, M. Nuclear medicine scans
tuberculosis most common) → bone, bone ▪ If MRI not attainable: higher radiotracer
marrow inflammation uptake
▪ Bacteria → bone via bloodstream, nearby
infection, open fractures/orthopedic CT scan, X-ray
implants ▪ not sensitive for 1–2 weeks
▪ First week: bacterial reproduction → ▫ Osteopenia (decreased bone density)
inflammation → bone necrosis (e.g. ▫ Periosteal reaction (thickening of
sequestrum); if periosteum bursts → periosteum)
abscess ▫ Aggressive infection → Codman’s
▪ Later: cytokines induce bone resorption triangle (lifted periosteum with triangle-
→ replacement with fibrous tissue → new shaped, ossified edge)
bone formation around necrotic one (e.g.
involucrum)

RISK FACTORS
▪ Diabetes, fractures, splenectomy,
orthopedic procedures/hardware

COMPLICATIONS
▪ If M. tuberculosis disseminates from joint to
vertebra → Pott disease
▪ Inadequate treatment → chronic infection
→ bone fractures, sepsis

SIGNS & SYMPTOMS

Local
▪ Redness, swelling, painful site, sinus
connecting to abscess

Systemic
▪ Weakness, fever, headache, shivering

DIAGNOSIS
DIAGNOSTIC IMAGING
MRI Figure 106.1 An X-ray image of the tibia
▪ Edema → signal changes demonstrating a radiolucency with a sclerotic
border consistent with a Brodie abscess.

588 OSMOSIS.ORG
 Chapter 106 Bone & Joint Infections

▫ Endosteal scalloping (focal resorption of

endosteum)
▫ Advanced osteomyelitis → cortical bone
breakage
▫ Peripheral sclerosis (increased density
at periphery, lower density centrally)

OTHER DIAGNOSTICS
Needle aspiration guided with ultrasound
▪ Specific antibiotic therapy

TREATMENT
MEDICATIONS
▪ Long-term intravenous antibiotics

SURGERY
▪ Surgical removal of dead bone
▪ Severe cases → amputation
Figure 106.2 A plain radiograph of the right
lower leg of an individual with postoperative
osteomyelitis. The surgical wound started
discharging pus two weeks post open
reduction. There is medial cortical destruction
and loss of trabeculations with lateral cortical
thickening.

SEPTIC ARTHRITIS
osms.it/septic-arthritis
RISK FACTORS
PATHOLOGY & CAUSES ▪ Diabetes
▪ Joint trauma
▪ Joint structures: infected, damaged
▪ Artificial joint, surgical procedure
▪ Pathogen enters the joint via bloodstream,
from nearby infection/directly (e.g. open ▪ Osteomyelitis
fracture) ▪ Chronic arthritis (e.g. rheumatoid arthritis)
▪ Infection of joint → endotoxin production → ▪ Immunocompromised
cytokine release → neutrophil attraction → ▪ HIV
inflammation, damage of joint structures

CAUSES
SIGNS & SYMPTOMS
▪ Most commonly S. aureus (any age group), ▪ Most commonly affects knee; less
Neisseria gonorrhoeae (N. gonorrhoeae; commonly ankle, hip, shoulder
sexual transmission → adults)

OSMOSIS.ORG 589
 Local
▪ Restricted range of motion; painful, warm,
swollen joint

Systemic
▪ Fever, weakness

DIAGNOSIS
DIAGNOSTIC IMAGING
X-ray, CT scan
▪ Normal in early stages
▪ ↑ fluid in synovial part of joint
▪ Narrowing of joint space due to destruction
of cartilage
▪ Destruction of bone adjacent to cartilage

MRI Figure 106.3 A red, hot, swollen left knee in

an individual with septic arthritis.
▪ Edema around synovium
▪ Assess spread of infection outside the joint

Ultrasound TREATMENT
▪ ↑ fluid
▪ Guiding needle for aspiration MEDICATIONS
▪ General antibiotics depending on Gram
LAB RESULTS stain of joint fluid
▪ Switch to specific antibiotics once bacteria
Blood test identified
▪ ↑ white blood cells count (WBC); ↑ ▪ Pain medications (e.g. NSAIDs,
sedimentation rate (ESR) acetaminophen)
Aspiration of joint fluid
▪ → bacterial culture → specific antibiotics SURGERY
▪ Surgically drain, cleanse joint fluid

590 OSMOSIS.ORG