The clinical and radiological evaluation of pyogenic arthritis

ABSTRACT

Pyogenic arthritis remain a difficult problem, despite the availability of a wide range of powerful modernantibiotics. Early and correct diagnosis is imperative to assure the prompt initiation of an effective therapeuticregimen and the prevent of late sequela. Careful clinical, laboratory and roentgenological analysis arefundamental to early and precise diagnosis. Therefore, plain roentgenogram shold not be overlooked. A radiologicaland clinical observation was made in 51 cases of pyogenic arthritis admittted to Chosun University Hospital duringthe period from January 1976 to Dec. 1983 and following results were obtained. 1. Among the 51 cases, 36 cases(70.6%) were male and 15 cases(29.4%) were females. The most prevalent age was 5 to 9 (27.6%). 2. Symptom durationless than 5 days was in 21 cases (41.2%) and more than 31 days was in 6 cases (11.7%). 3. The most common symptomon admission was pain around the involved joint and others are limitation of motion, swelling, tenderness, fever,local heating and erythema. 4. The underlying causes were composed of unknown in 21 cases(41.2%), trauma in 18cases(35.3%), infections focus in 8 cases (15.7%) and iatrogenic reasone 4 cases(7.8%) 5. The msot commonlyaffected joint was hip joint (45.1%). The other affected sites in order of frequency were knee, ankle, shoulder,S-I and elbow joint. In infants and children, hip and knee joint are commonly affected; In adults, knee joint ismost commonly affected. 6. In laboratory findings, the number of W.B.C and E.S.R were increased in 56.9%. Symptomduration more than 31 days in 5 cases were increased E.S,R only. Causative microorganism was isolated in 31 cases;the most common microorganism was Staphylococcus auterus in 22 cases. Others are B-hemolytic Streptococcus,Enterobacteriaceae species and Pseudomonas aeruginosa. 7. In 26 cases(50.9%) of the patients, roentgenographicfinding was negative. The most common radiological findig was soft tissue swelling and the others are include inorder of frequency joint space widening, small erosions in articular cortex, subchondral osteoporosis. The comonradiological findings of symptom duration more than 31 days in 6 cases were lost of entire cortex, ankylosis andjoint space narrwoing.