Bone And Joint Infection Management
Types of Bone & Joint Infections
NYU Langone physicians are experienced in identifying and treating bone infections, known as osteomyelitis, and joint infections, or septic arthritis. These infections begin when disease-carrying bacteria enter the body, often after a trauma or a surgical procedure, and spread to the bones and joints through the bloodstream. Without prompt treatment, bone and joint infections can become long-term conditions. Many types of bacteria can cause bone and joint infections, including Staphylococcus aureus, also called staph, Enterobacter, and Streptococcus.
Osteomyelitis
Osteomyelitis often occurs when an infection elsewhere in the body, such as a urinary tract infection or pneumonia, spreads through the blood to the bones. Sometimes, a recent surgery, an injection around a bone, or an open fracture—when a bone punctures the skin—can expose bone to bacteria, causing osteomyelitis.
An open wound over a bone can also lead to osteomyelitis. This condition is most common in people who have diabetes and diabetic foot ulcers. It also can develop in people who have peripheral neuropathy, in which nerve damage makes it difficult to detect an injury in the limbs.
Initially, osteomyelitis develops rapidly and is usually accompanied by pain, fever, and stiffness. Chronic osteomyelitis progresses slowly and may be the result of a previous bone infection. Despite multiple courses of antibiotics, the condition may return if the bacteria causing the infection become resistant to antibiotics. Symptoms of chronic osteomyelitis may include fever, pain, and redness or discharge at the site of the infection.
Adults are more likely to develop osteomyelitis in the vertebrae—the bones of the spine—or in a part of the body where they’ve previously had surgery for a fracture or had joint replacement.
Adults tend to develop chronic symptoms, such as pain at the site of injury or surgery. They may also experience tenderness, swelling, warmth, or redness over the affected bone. People with diabetes or peripheral neuropathy may not have pain or a fever, but they may notice that an injured area of skin, such as a foot ulcer, is not healing.
In children, osteomyelitis usually affects the long bones in the legs and upper arms, including the femur and the humerus. Symptoms may include fever, chills, redness at the site of infection, pain or tenderness over the affected bone, and difficulty using the affected limb. They may, for instance, have trouble walking due to severe pain in the legs.
Septic Arthritis
Septic arthritis is the inflammation of a joint due to a bacterial or fungal infection. The condition occurs when a penetrating injury, such as a puncture wound, occurs near or above a joint, allowing bacteria to directly enter the joint. Bacteria can also spread through the bloodstream to a joint from a recent infection or after surgery.
It often affects the joints near long bones in the legs and arms. These include the hip, knee, and ankle joints and the shoulder, elbow, and wrist joints. The infection can also occur in the spine, pelvis, and heels.
Infants and older adults are most vulnerable to septic arthritis due to their anatomy and blood supply to the joints. The knee and hip are the most commonly affected joints in adults, whereas the hip is the most common site of infection in infants.
Septic arthritis can quickly cause severe damage to the cartilage and bone within a joint. Prompt treatment is critical for preventing permanent joint damage.
Symptoms are usually severe and include fever, redness, and swelling at the joint and intense pain that worsens with movement. In infants, symptoms may include a fever, the inability to move the limb with the infected joint, and crying when the infected joint is moved. For instance, infants with septic arthritis in a hip joint may cry when having a diaper change.
Surgery for Osteomyelitis
Doctors may recommend a procedure called debridement to remove dead or damaged bone tissue in people with osteomyelitis. During this procedure, the doctor cuts away dead or damaged bone tissue. He or she also washes the wound to remove any dead or loose tissue.
Doctors may eventually replace the removed bone with a graft, a small piece of bone taken from your hip or from a bone bank, a facility that stores donated bone tissue. During this procedure, the doctor may implant antibiotics directly into the bone.
A skin graft may also be needed if the skin around the bone or joint is infected and doesn’t heal. In a skin graft, an NYU Langone plastic surgeon removes the infected skin and replaces it with healthy skin or muscle into the area. Doctors usually take a patch of skin from the buttocks, inner thigh, or another part of the body. The healthy skin is anchored into place with staples or a few small stitches.
Sometimes, the surgeon also moves some muscle to cover an area around a bone or joint infection. This can promote healing, because the muscle provides healthy blood flow to the bone or joint. Surgeons can often perform skin and muscle grafts at the same time as debridement.
If the infection is deep within the body or a bone is being removed, your doctor may give you general anesthesia before the procedure. If the infection is closer to the surface, he or she numbs the area around the wound with a regional or local anesthetic. You may be given a sedative to help you relax during the procedure.
It can be difficult to completely eliminate osteomyelitis, which can become a chronic infection. Some people may need multiple surgeries to completely remove the damaged or dead bone.
Surgery for Septic Arthritis
For people with septic arthritis, doctors may first remove the infected joint fluid before deciding if surgery is necessary. The doctor often withdraws the infected fluid with a needle inserted into the joint.
Draining may be performed daily over the course of several days or weeks, until the infection is cleared. Some joints, such as the hip, are more difficult to drain with a needle, so you may need surgery.
If a joint implant becomes infected, you may need surgery to remove the prosthetic device and the surrounding infected tissue. An orthopaedic surgeon may replace the device with a temporary antibiotic spacer to manage the infection. This spacer is left in place for a few months while the body heals and the infection is eliminated. Doctors then perform a second surgery to implant a new prosthetic joint.
Infected joints may be treated with a minimally invasive arthroscopic procedure or open surgery, which is called arthrotomy. With either approach, doctors remove the infected lining of the joint, in a procedure called synovectomy, and wash the area with fluid to decrease the amount of bacteria there.
After surgery, IV antibiotics are required for several months to prevent the infection from returning.