When is surgical drainage absolutely indicated for a septic joint

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.

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