- 0
Highlights & Basics
- Septic arthritis is usually, but not always, monoarticular, and presents with a painful, hot, swollen joint with restricted motion. A high index of suspicion is required because septic arthritis is a medical emergency and should be diagnosed as early as possible.
- Diagnosis is based on clinical assessment and bacteriologic confirmation.
- In all cases of suspected native joint sepsis, the joint should be aspirated. For patients with concern for prosthetic joint infection, orthopedic consult is indicated.
- Empiric antibiotic therapy should be commenced ideally once appropriate cultures have been taken.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Citations
Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18.[Abstract]
Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.[Abstract][Full Text]
Ravn C, Neyt J, Benito N, et al. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect. 2023;8(1):29-37.[Abstract][Full Text]
Benito N, Martínez-Pastor JC, Lora-Tamayo J, et al. Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT. Enferm Infecc Microbiol Clin (Engl Ed). 2024 Apr;42(4):208-14.[Abstract][Full Text]
American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].[Full Text]
Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].[Full Text]
Le Vavasseur B, Zeller V. Antibiotic therapy for prosthetic joint infections: an overview. Antibiotics (Basel). 2022 Apr 5;11(4):486.[Abstract][Full Text]
1. Tarkowski A. Infection and musculoskeletal conditions: infectious arthritis. Best Pract Res Clin Rheumatol. 2006 Dec;20(6):1029-44.[Abstract]
2. Roerdink RL, Huijbregts HJTAM, van Lieshout AWT, et al. The difference between native septic arthritis and prosthetic joint infections: a review of literature. J Orthop Surg (Hong Kong). 2019 May-Aug;27(2):2309499019860468.[Abstract][Full Text]
3. Alexandersson H, Dehlin M, Jin T. Increased incidence and clinical features of septic arthritis in patients aged 80 years and above: a comparative analysis with younger cohorts. Pathogens. 2024 Oct 11;13(10):891.[Abstract][Full Text]
4. He M, Arthur Vithran DT, Pan L, et al. An update on recent progress of the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis: a review. Front Cell Infect Microbiol. 2023;13:1193645.[Abstract][Full Text]
5. Rutherford AI, Subesinghe S, Bharucha T, et al. A population study of the reported incidence of native joint septic arthritis in the United Kingdom between 1998 and 2013. Rheumatology (Oxford). 2016 Dec;55(12):2176-80.[Abstract]
6. Ross JJ. Septic arthritis of native joints. Infect Dis Clin North Am. 2017 Jun;31(2):203-18.[Abstract]
7. Eka A, Chen AF. Patient-related medical risk factors for periprosthetic joint infection of the hip and knee. Ann Transl Med. 2015 Sep;3(16):233.[Abstract][Full Text]
8. Orthobullets. Septic arthritis - adult. Jan 2025 [internet publication].[Full Text]
9. Earwood JS, Walker TR, Sue GJC. Septic arthritis: diagnosis and treatment. Am Fam Physician. 2021 Dec 1;104(6):589-97.[Abstract][Full Text]
10. Arnold SR, Elias D, Buckingham SC, et al. Changing patterns of acute hematogenous osteomyelitis and septic arthritis: emergence of community-associated methicillin-resistant Staphylococcus aureus. J Pediatr Orthop. 2006 Nov-Dec;26(6):703-8.[Abstract]
11. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus (MRSA): methicillin-resistant Staphylococcus aureus (MRSA) basics. Jun 2025 [internet publication].[Full Text]
12. Chan BY, Crawford AM, Kobes PH, et al. Septic arthritis: an evidence-based review of diagnosis and image-guided aspiration. AJR Am J Roentgenol. 2020 Sep;215(3):568-81.[Abstract][Full Text]
13. Vidaurrazaga MM, Perlman DC. A case of purulent gonococcal arthritis. IDCases. 2020;19:e00662.[Abstract][Full Text]
14. Weston EJ, Heidenga BL, Farley MM, et al. Surveillance for disseminated gonococcal infections, active bacterial core surveillance (ABCs)-United States, 2015-2019. Clin Infect Dis. 2022 Sep 29;75(6):953-8.[Abstract][Full Text]
15. Dubost JJ, Soubrier M, De Champs C, et al. No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis. 2002 Mar;61(3):267-9.[Abstract][Full Text]
16. Brook I, Frazier EH. Anaerobic osteomyelitis and arthritis in a military hospital: a 10-year experience. Am J Med. 1993 Jan;94(1):21-8.[Abstract]
17. Brandariz-Núñez D, Gálvez-López J. Septic arthritis caused by Bacteroides thetaiotaomicrom: a case report and review. Rev Esp Quimioter. 2021 Dec;34(6):675-8.[Abstract][Full Text]
18. Kaandorp CJ, Dinant HJ, van de Laar MA, et al. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis. 1997 Aug;56(8):470-5.[Abstract][Full Text]
19. Weston VC, Jones AC, Bradbury N, et al. Clinical features and outcome of septic arthritis in a single UK health district 1982-1991. Ann Rheum Dis. 1999 Apr;58(4):214-9.[Abstract][Full Text]
20. Gupta MN, Sturrock RD, Field M. A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford). 2001 Jan;40(1):24-30.[Abstract][Full Text]
21. Sharp JT, Lidsky MD, Duffy J, et al. Infectious arthritis. Arch Intern Med. 1979 Oct;139(10):1125-30.[Abstract]
22. Darwitz BP, Genito CJ, Thurlow LR. Triple threat: how diabetes results in worsened bacterial infections. Infect Immun. 2024 Sep 10;92(9):e0050923.[Abstract][Full Text]
23. American Academy of Orthopaedic Surgeons. Diagnosis and prevention of periprosthetic joint infections. Mar 2019 [internet publication].[Full Text]
24. Horn AR, Diamond KB, Ng MK, et al. The association of alcohol use disorder with perioperative complications following primary total hip arthroplasty. Hip Pelvis. 2021 Dec;33(4):231-8.[Abstract][Full Text]
25. Meijers KA, Dijkmans BA, Hermans J, et al. Non-gonococcal infectious arthritis: a retrospective study. J Infect. 1987 Jan;14(1):13-20.[Abstract]
26. Coakley G, Mathews C, Field M, et al. BSR and BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford). 2006 Aug;45(8):1039-41.[Abstract][Full Text]
27. National Institute for Health and Care Excellence. Sepsis: recognition, diagnosis and early management. Mar 2024 [internet publication].[Full Text]
28. Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143.[Abstract][Full Text]
29. Gupta MN, Sturrock RD, Field M. Prospective comparative study of patients with culture proven and high suspicion of adult onset septic arthritis. Ann Rheum Dis. 2003 Apr;62(4):327-31.[Abstract][Full Text]
30. Rice PA. Gonococcal arthritis (disseminated gonococcal infection). Infect Dis Clin North Am. 2005 Dec;19(4):853-61.[Abstract]
31. García-Arias M, Balsa A, Mola EM. Septic arthritis. Best Pract Res Clin Rheumatol. 2011 Jun;25(3):407-21.[Abstract]
32. Centers for Disease Control and Prevention. Sexually transmitted infections treatment guidelines, 2021: gonococcal infections among adolescents and adults. Sep 2022 [internet publication].[Full Text]
33. Dey M, Al-Attar M, Peruffo L, et al. Assessment and diagnosis of the acute hot joint: a systematic review and meta-analysis. Rheumatology (Oxford). 2023 May 2;62(5):1740-56.[Abstract][Full Text]
34. Miller JM, Binnicker MJ, Campbell S, et al. Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2024 update by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM). Clin Infect Dis. 2024 Mar 5:ciae104.[Abstract][Full Text]
35. Ravn C, Neyt J, Benito N, et al. Guideline for management of septic arthritis in native joints (SANJO). J Bone Jt Infect. 2023;8(1):29-37.[Abstract][Full Text]
36. Margaretten ME, Kohlwes J, Moore D, et al. Does this adult patient have septic arthritis? JAMA. 2007 Apr 4;297(13):1478-88.[Abstract]
37. Dooley DP. Aspiration of the possibly septic joint through potential cellulitis: just do it!. J Emerg Med. 2002 Aug;23(2):210.[Abstract]
38. Long B, Koyfman A, Gottlieb M. Evaluation and management of septic arthritis and its mimics in the emergency department. West J Emerg Med. 2019 Mar;20(2):331-41.[Abstract][Full Text]
39. Ahmed I, Gertner E. Safety of arthrocentesis and joint injection in patients receiving anticoagulation at therapeutic levels. Am J Med. 2012 Mar;125(3):265-9.[Abstract][Full Text]
40. Bashir MA, Ray R, Sarda P, et al. Determination of a safe INR for joint injections in patients taking warfarin. Ann R Coll Surg Engl. 2015 Nov;97(8):589-91.[Abstract][Full Text]
41. The Primary Care Rheumatology and Musculoskeletal Medicine Society. Joint and Soft Tissue Injection Recommendations. 2021 [internet publication].[Full Text]
42. Mushtaq S, Choudhary R, Scanzello CR. Non-surgical treatment of osteoarthritis-related pain in the elderly. Curr Rev Musculoskelet Med. 2011 Sep;4(3):113-22.[Abstract][Full Text]
43. Benito N, Martínez-Pastor JC, Lora-Tamayo J, et al. Executive summary: guidelines for the diagnosis and treatment of septic arthritis in adults and children, developed by the GEIO (SEIMC), SEIP and SECOT. Enferm Infecc Microbiol Clin (Engl Ed). 2024 Apr;42(4):208-14.[Abstract][Full Text]
44. Subedi S, Isler B, Ezure Y, et al. Performance characteristics of genus or species-specific Polymerase Chain Reaction (PCR) for the microbial diagnosis of joint infections: a systematic review and meta-analysis. Diagn Microbiol Infect Dis. 2024 Sep;110(1):116422.[Abstract][Full Text]
45. Marais LC, Nieuwoudt L, Nansook A, et al. Tuberculous arthritis of native joints - a systematic review and European Bone and Joint Infection Society workgroup report. J Bone Jt Infect. 2023;8(4):189-207.[Abstract][Full Text]
46. British Orthopaedic Association. Speciality standards (SpecS) - peri-prosthetic joint infection. Apr 2024 [internet publication].[Full Text]
47. Walinga AB, Stornebrink T, Langerhuizen DWG, et al. What are the best diagnostic tests for diagnosing bacterial arthritis of a native joint? : a systematic review of 27 studies. Bone Joint J. 2021 Dec;103-B(12):1745-53.[Abstract]
48. West K, Almekdash H, Fisher J, et al. Procalcitonin as a predictor of septic knee arthritis: a retrospective cohort study. J Am Acad Orthop Surg Glob Res Rev. 2023 Jan 1;7(1):e22.00261.[Abstract][Full Text]
49. Simundic AM, Bölenius K, Cadamuro J, et al. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med. 2018;56(12):2015-38.[Abstract]
50. Couderc M, Bart G, Coiffier G, et al. 2020 French recommendations on the management of septic arthritis in an adult native joint. Joint Bone Spine. 2020 Dec;87(6):538-47.[Abstract][Full Text]
51. Nijhof MW, Oyen WJ, van Kampen A, et al. Evaluation of infections of the locomotor system with indium-111-labeled human IgG scintigraphy. J Nucl Med. 1997 Aug;38(8):1300-5.[Abstract][Full Text]
52. Karchevsky M, Schweitzer ME, Morrison WB, et al. MRI findings of septic arthritis and associated osteomyelitis in adults. Am J Roentgenol. 2004 Jan;182(1):119-22.[Abstract][Full Text]
53. American College of Radiology. ACR appropriateness criteria: suspected osteomyelitis, septic arthritis, or soft tissue infection (excluding spine and diabetic foot). 2022 [internet publication].[Full Text]
54. Beaufrère M, Pressat-Laffouilhère T, Marcelli C, et al. Valvular and infection-associated risk factors as criteria to guide the use of echocardiography in patients with native joint infections. Semin Arthritis Rheum. 2021 Dec;51(6):1274-81.[Abstract]
55. Della Valle C, Parvizi J, Bauer TW, et al. American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee. J Bone Joint Surg Am. 2011 Jul 20;93(14):1355-7.[Abstract][Full Text]
56. Brennan-Olsen SL, Cook S, Leech MT, et al. Prevalence of arthritis according to age, sex and socioeconomic status in six low and middle income countries: analysis of data from the World Health Organization study on global AGEing and adult health (SAGE) wave 1. BMC Musculoskelet Disord. 2017 Jun 21;18(1):271.[Abstract][Full Text]
57. Yagupsky P, Press J. Use of the isolator 1.5 microbial tube for culture of synovial fluid from patients with septic arthritis. J Clin Microbiol. 1997 Sep;35(9):2410-2.[Abstract][Full Text]
58. von Essen R. Culture of joint specimens in bacterial arthritis. Impact of blood culture bottle utilization. Scand J Rheumatol. 1997;26(4):293-300.[Abstract]
59. Bell J, Rasmussen L, Kumar A, et al. Septic arthritis in immunosuppressed patients: do laboratory values help? J Am Acad Orthop Surg Glob Res Rev. 2020 Mar;4(3):e20.00007.[Abstract][Full Text]
60. Wu KA, Kugelman DN, Seidelman JL, et al. Native joint septic arthritis. Antibiotics (Basel). 2024 Jun 27;13(7):596.[Abstract][Full Text]
61. Horowitz DL, Katzap E, Horowitz S, et al. Approach to septic arthritis. Am Fam Physician. 2011 Sep 15;84(6):653-60.[Abstract][Full Text]
62. Aggarwal P, Mahapatra S, Avasthi S, et al. Role of serum and synovial procalcitonin in differentiating septic from non-septic arthritis- a prospective study. J Clin Orthop Trauma. 2022 Aug;31:101948.[Abstract]
63. Sager R, Kutz A, Mueller B, et al. Procalcitonin-guided diagnosis and antibiotic stewardship revisited. BMC Med. 2017 Jan 24;15(1):15.[Abstract][Full Text]
64. Mathews CJ, Coakley G; British Society for Rheumatology. Hot joint update 2017. Mar 2017 [internet publication].[Full Text]
65. Le Vavasseur B, Zeller V. Antibiotic therapy for prosthetic joint infections: an overview. Antibiotics (Basel). 2022 Apr 5;11(4):486.[Abstract][Full Text]
66. Pellegrini A, Suardi V, Legnani C. Classification and management options for prosthetic joint infection. Ann Jt. 2022;7:3.[Abstract][Full Text]
67. Davis JS, Metcalf S, Clark B, et al. Predictors of treatment success after periprosthetic joint infection: 24-month follow up from a multicenter prospective observational cohort study of 653 patients. Open Forum Infect Dis. 2022 Mar;9(3):ofac048.[Abstract][Full Text]
68. Nelson SB, Pinkney JA, Chen AF, et al. Periprosthetic joint infection: current clinical challenges. Clin Infect Dis. 2023 Oct 5;77(7):e34-45.[Abstract][Full Text]
69. Rotem G, Zur-Aviran N, Sherr-Lurie N, et al. Treatment of septic arthritis of the hip joint using repeated aspirations: when should we operate? Indian J Orthop. 2022 Jun;56(6):1090-5.[Abstract]
70. Balato G, de Matteo V, Ascione T, et al. Management of septic arthritis of the hip joint in adults. a systematic review of the literature. BMC Musculoskelet Disord. 2021 Dec 2;22(suppl 2):1006.[Abstract][Full Text]
71. Acosta-Olivo C, Vilchez-Cavazos F, Blázquez-Saldaña J, et al. Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis. Int Orthop. 2021 Aug;45(8):1947-59.[Abstract]
72. Smith C, Maloney RJ, Wearmouth D, et al. Multi-centre evaluation of Gram stain in the diagnosis of septic arthritis. J Bone Jt Infect. 2025;10(2):61-71.[Abstract][Full Text]
73. McDanel JS, Roghmann MC, Perencevich EN, et al. Comparative effectiveness of cefazolin versus nafcillin or oxacillin for treatment of methicillin-susceptible staphylococcus aureus infections complicated by bacteremia: a nationwide cohort study. Clin Infect Dis. 2017 Jul 1;65(1):100-6.[Abstract][Full Text]
74. Richards DM, Heel RC, Brogden RN, et al. Ceftriaxone. a review of its antibacterial activity, pharmacological properties and therapeutic use. Drugs. 1984 Jun;27(6):469-527.[Abstract][Full Text]
75. Auzin A, Spits M, Tacconelli E, et al. What is the evidence base of used aggregated antibiotic resistance percentages to change empirical antibiotic treatment? a scoping review. Clin Microbiol Infect. 2022 Jul;28(7):928-35.[Abstract][Full Text]
76. Ross JJ, Ard KL, Carlile N. Septic arthritis and the opioid epidemic: 1465 cases of culture-positive native joint septic arthritis from 1990-2018. Open Forum Infect Dis. 2020 Mar;7(3):ofaa089.[Abstract][Full Text]
77. Gobao VC, Alfishawy M, Smith C, et al. Risk factors, screening, and treatment challenges in Staphylococcus aureus native septic arthritis. Open Forum Infect Dis. 2021 Jan;8(1):ofaa593.[Abstract][Full Text]
78. Hassan AS, Rao A, Manadan AM, et al. Peripheral bacterial septic arthritis: review of diagnosis and management. J Clin Rheumatol. 2017 Dec;23(8):435-42.[Abstract]
79. Karruli A, Catalini C, D'Amore C, et al. Evidence-based treatment of Pseudomonas aeruginosa infections: a critical reappraisal. Antibiotics (Basel). 2023 Feb 16;12(2):399.[Abstract][Full Text]
80. Jangra V, Sharma N, Chhillar AK. Therapeutic approaches for combating Pseudomonas aeruginosa infections. Microbes Infect. 2022 Jun;24(4):104950.[Abstract][Full Text]
81. Ripa M, Rodríguez-Núñez O, Cardozo C, et al. Influence of empirical double-active combination antimicrobial therapy compared with active monotherapy on mortality in patients with septic shock: a propensity score-adjusted and matched analysis. J Antimicrob Chemother. 2017 Aug 31;72(12):3443-52.[Full Text]
82. Tschudin-Sutter S, Fosse N, Frei R, et al. Combination therapy for treatment of Pseudomonas aeruginosa bloodstream infections. PLoS One. 2018;13(9):e0203295.[Abstract][Full Text]
83. Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804.[Abstract][Full Text]
84. David MZ, Daum RS. Treatment of Staphylococcus aureus Infections. Curr Top Microbiol Immunol. 2017;409:325-83.[Abstract]
85. Bhambri S, Kim G. Use of oral doxycycline for community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections. J Clin Aesthet Dermatol. 2009 Apr;2(4):45-50.[Abstract][Full Text]
86. Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the infectious diseases society of america for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children. Clin Infect Dis. 2011 Feb 1;52(3):e18-55.[Abstract][Full Text]
87. Zakhour J, Sharara SL, Hindy JR, et al. Antimicrobial treatment of Pseudomonas aeruginosa severe sepsis. Antibiotics (Basel). 2022 Oct 18;11(10):1432.[Abstract][Full Text]
88. Gómez BO, Feito CR, Vázquez DG, et al. Primary meningococcal septic arthritis case report and literature review of an unusual manifestation of meningococcal disease. Bull Hosp Jt Dis (2013). 2019 Mar;77(2):140-5.[Abstract]
89. Gyamfi-Brobbey G, Clark SA, Campbell H, et al. An analysis of Neisseria meningitidis strains causing meningococcal septic arthritis in England and Wales: 2010-2020. J Infect. 2022 Oct;85(4):390-6.[Abstract][Full Text]
90. Osmon DR, Berbari EF, Berendt AR, et al. Executive summary: diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013 Jan;56(1):1-10.[Abstract][Full Text]
91. Abram SGF, Alvand A, Judge A, et al. Mortality and adverse joint outcomes following septic arthritis of the native knee: a longitudinal cohort study of patients receiving arthroscopic washout. Lancet Infect Dis. 2020 Mar;20(3):341-9.[Abstract]
92. Walinga AB, Stornebrink T, Emanuel KS, et al. Failure rates in surgical treatment in adults with bacterial arthritis of a native joint: a systematic review of 8,586 native joints. Arch Orthop Trauma Surg. 2023 Nov;143(11):6547-59.[Abstract][Full Text]
93. Kaandorp CJ, Krijnen P, Moens HJ, et al. The outcome of bacterial arthritis:a prospective community-based study. Arthritis Rheum. 1997 May;40(5):884-92.[Abstract]
