When is surgical drainage absolutely indicated for a septic joint?
• Infected hip and shoulder joints.
• Vertebral osteomyelitis with cord compression.
• Anatomically difficult-to-drain joints (i.e., sternoclavicular joint).
• Inability to remove purulent fluid by needle drainage because fluid is too thick or loculated.
• Joints failing to respond to needle drainage (i.e., persistent positive cultures of synovial fluid or failure of synovial WBC to decrease).
• Prosthetic joints.
• Associated osteomyelitis requiring surgical drainage.
• Arthritis associated with foreign body.
• Delayed onset of therapy (>7 days)—irreversible cartilage damage starts within 1 week.