Intra-articular joint infections are orthopedic emergencies and require urgent surgical irrigation and debridement as well as long-term antibiotic therapy. The most common source of infection is Staphylococcus aureus, which aggressively and quickly destroys cartilage and leaves the patient with permanent OA. Patients with a knee joint infection present with increased pain, swelling, warmth, redness, fever, and decreased ability to ambulate on that leg. Most patients will not want to move their knee at all. The knee should be aspirated and the fluid inspected and sent for laboratory analysis (Gram stain, cell count, culture, crystal evaluation). Crystalline arthropathy such as gout should always be considered because the aspirated fluid often appears cloudy and may mimic a joint infection. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) should also be obtained. Appropriate antibiotic treatment is initiated based on the offending organism. Although proposed in the medical literature for low-virulent organisms, serial aspiration is discouraged in the orthopedic literature, with surgical irrigation the preferred treatment.
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