Treatment of Osteomyelitis (Bone Infection) & Septic Arthritis

Two related problems

Osteomyelitis is infection inside a bone. Septic arthritis is infection inside a joint, where organisms multiply in the joint fluid itself. They are treated together here because they arise in similar ways and share the same principles of management. What separates them is the tissue involved: a joint is lined with cartilage, and infected joint fluid can damage that surface, which is why infection within a joint is generally regarded as urgent.

The background to bone infection itself, including how organisms reach bone and what makes some people more susceptible, is covered on our page about osteomyelitis as a condition. This page describes what treatment involves.

Findings that prompt urgent assessment

• A joint that becomes painful, hot and swollen quickly, often with pain on any movement
• Fever or chills accompanying pain in a bone or joint
• Drainage from a wound over bone, or near a previous operation
• Increasing pain around an implant or old fracture that had been comfortable
• A wound that will not close over bone

How treatment is planned

The first step is generally to establish what is being treated. Identifying the organism allows antimicrobial therapy to be directed rather than presumptive, so samples of fluid, tissue or bone are commonly obtained before treatment is committed. In a suspected joint infection this often means aspirating fluid for culture; in suspected bone infection, a biopsy or samples taken during a procedure. Imaging defines how far the infection extends, whether dead bone is present, and whether an implant is involved. Orthopedic care is usually coordinated with infectious disease specialists.

What treatment can involve

Some infections, particularly those identified early and without dead bone or an involved implant, may be managed without a major operation.

• Culture-directed antimicrobial therapy. Treatment selected according to the organism identified and supervised by an infectious disease physician.
• Aspiration and drainage. Removing infected fluid from a joint may be both diagnostic and part of treatment.
• Protection and support. Splinting, bracing or limiting load may be advised while the infection is brought under control.
• Managing contributing conditions. Blood sugar control, circulation, nutrition and tobacco use are commonly addressed alongside the infection.

Surgery is frequently part of treating established bone infection, particularly when tissue has died or infection is walled off from the bloodstream.

• Debridement. Infected and dead bone and soft tissue are removed so the remaining tissue is healthy and reachable by the body's defenses and by medication.
• Joint washout. An infected joint may be irrigated and cleaned, arthroscopically or through an open approach.
• Dead space and hardware management. The cavity left after debridement may be filled or managed, and an implant involved in infection may be removed, exchanged or replaced in stages.
• Staged reconstruction. Once infection is controlled, missing bone may be reconstructed. A circular frame using the Ilizarov method of gradual distraction allows a healthy segment of bone to be transported across a defect so new bone forms behind it.

What to expect when you consult Dr. Wolfson

Dr. Wolfson trained in the Ilizarov method of limb lengthening and reconstruction, techniques developed in large part to treat bone infection and the bone loss that follows it, and he sees patients with infection after trauma and after previous surgery. A consultation typically covers what testing has been done, how orthopedic and infectious disease care will be sequenced, and what reconstruction may involve if bone has been lost.

This page provides general information about the treatment of bone and joint infection and is not medical advice. It is not a substitute for examination, imaging and diagnosis by a qualified physician. Every case is different and requires individual evaluation. If you have severe pain, an obvious deformity, loss of function, fever, or an injury from a significant accident, seek medical care promptly.

Contact Dr. Wolfson if you would like to setup an appointment. If you are a new patient, please book all in-person appointments with Dr. Wolfson via telephone.

If you live outside of the San Francisco Bay Area, you can request a complimentary phone consultation with Dr. Wolfson to assess your case. Please call or e-mail us to set up your complimentary consultation.

Call: (415) 221-4400

E-mail: [email protected]