Surgical Options and Approaches for Septic Arthritis of the Native Hip and Knee Joint


      Septic arthritis (SA) of the adult knee and hip is a constantly evolving and urgent surgical issue. The epidemiology has shifted over the last few decades as have the most popular antibiotics and surgical treatments. SA of all types is increasing in the United States. There remains a high variability in the conservative and surgical management options available. This review will outline the most current understanding of the etiology and epidemiology of SA and will also discuss the distribution of causative organisms and appropriate treatments for each. A summary of evidence for different debridement and reconstructive techniques will also be presented in addition to novel areas of research to decrease the morbidity of this constantly growing problem.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Sharff K.A.
        • Richards E.P.
        • Townes J.M.
        Clinical management of septic arthritis.
        Curr Rheumatol Rep. 2013; 15: 332
        • Ross J.J.
        Septic arthritis of native joints.
        Infect Dis Clin North Am. 2017; 31: 203-218
        • Hassan A.S.
        • Rao A.L.
        • Manadan A.M.
        • Block J.A.
        Peripheral bacterial septic arthritis: review of diagnosis and management.
        J Clin Rheum. 2017; 23: 435-442
        • Jung S.W.
        • Kim D.H.
        • Shin S.J.
        • Kang B.Y.
        • Eho Y.J.
        • Yang S.W.
        Septic arthritis associated with systemic sepsis.
        Int Orthop (Sicot). 2018; 42: 1-7
        • Jung D.
        • Park K.
        Early result of treatment for osteomyelitis with septic knee arthritis in patients with severe arthritis by staged total knee arthroplasty using the prostalac articulating spacer.
        Orthop Proceed. 2018; 99: 5
        • Uckay I.
        • Tovmirzaeva L.U.
        • Garbino J.O.
        • Rohner P.E.
        • Tahintzi P.
        • Suva D.
        • et al.
        Short parenteral antibiotic treatment for adult septic arthritis after successful drainage.
        Int J Infect Dis. 2013; 17: e199-e205
        • Jaffe D.A.
        • Costales T.I.
        • Greenwell P.A.
        • Christian M.A.
        • Henn 3rd, R.F.
        Methicillin-resistant Staphylococcus aureus infection is a risk factor for unplanned return to the operating room in the surgical treatment of a septic knee.
        J Knee Surg. 2017; 30: 872-878
        • Fleck E.E.
        • Spangehl M.J.
        • Rapuri V.R.
        • Beauchamp C.P.
        An articulating antibiotic spacer controls infection and improves pain and function in a degenerative septic hip.
        Clin Orthop Relat Res. 2011; 469: 3055-3064
        • Diwanji S.R.
        • Kong I.K.
        • Park Y.H.
        • Cho S.G.
        • Song E.K.
        • Yoon T.R.
        Two-stage reconstruction of infected hip joints.
        J Arthroplasty. 2008; 23: 656-661
        • Kiraplani P.A.
        • Choi Y.I.
        • Koh H.S.
        • Kim J.M.
        • Han C.W.
        Two-stage total knee arthroplasty for non-salvageable septic arthritis in diabetes mellitus patients. Acta Orthop.
        Belg. 2005; 71: 315-320
        • Jeong W.K.
        • Park J.H.
        • Lee H.S.
        • Park J.W.
        • Han S.B.
        • Lee D.H.
        Septic arthritis of the knee joint secondary to adjacent chronic osteomyelitis of the femur in an adult.
        Knee Surg Sports Traumatol Arthrosc. 2010; 18: 790-793
        • Nazarian D.G.
        • Jesus D.D.
        • McGuigan F.R.
        • Booth R.E.
        A two-stage approach to primary knee arthroplasty in the infected arthritic knee.
        J Arthroplasty. 2003; 18: 16-21
        • Maheshwari A.V.
        • Gioe T.J.
        • Kalore N.V.
        • Cheng E.Y.
        Reinfection after prior staged reimplantation for septic total knee arthroplasty: is salvage still possible?.
        J Arthroplasty. 2010; 25: 92-97
        • Huang T.W.
        • Huang K.C.
        • Lee P.C.
        • Tai C.L.
        • Hsieh P.H.
        Encouraging outcomes of staged, uncemented arthroplasty with short-term antibiotic therapy for treatment of recalcitrant septic arthritis of the native hip.
        J Trauma. 2010; 68: 4
        • Shen H.A.
        • Wang Q.J.
        • Zhang X.L.
        • Jiang Y.A.
        Novel articulating medullary-sparing spacer for the treatment of infectious hip arthritis.
        Orthopedics. 2013; 36: e404-e408
        • Li W.E.
        • Fang X.I.
        • Zhang C.H.
        • Xu Y.E.
        • Huang Z.
        • Yu Z.
        • et al.
        Comparison of efficacy and complications between two types of staging arthroplasty in treating chronic septic hip arthritis: a retrospective clinical study.
        Exp Ther Med. 2019; 17: 4123-4131