Table of ContentsView AllTable of ContentsSymptomsCausesDiagnosisTreatmentPreventionConcurrent Infections
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Diagnosis
Treatment
Prevention
Concurrent Infections
Septic osteomyelitisandseptic arthritisare infections of a bone and asynovial joint. They are sometimes discussed together because they have many similarities and can occur at the same time. There are also several differences between the two conditions.
Keep reading to learn about septic osteomyelitis and septic arthritis, their symptoms, causes, how they are diagnosed and treated, and more.
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Both osteomyelitis and septic arthritis are rare, and they can be life-threatening. Early diagnosis and treatment are vital to reducing the potential for complications. Both conditions are suspected—either alone or together—when someone reports fever along with joint symptoms.
Septic Osteomyelitis
Septic osteomyelitis can be acute or chronic.Acute osteomyelitis can result from bacteremia (a blood stream infection), injury, or surgery. When treated, it usually resolves within a couple of weeks. Chronic osteomyelitis occurs after an acute episode doesn’t fully resolve.
The first symptom of septic osteomyelitis is usually pain in the affected bone. Other symptoms might include:
Additional symptoms that might be associated with septic osteomyelitis include:
Chronic osteomyelitis can cause severe bone pain, swelling, redness, and tenderness. A person with the condition may also experience pus drainage from an open area of the affected bone.
Chronic osteomyelitis might lead to the destruction of the bone where pieces of bone will separate from the healthy bone.In these cases, surgery is required to remove bone fragments.
Septic Arthritis
Symptoms of septic arthritis might include:
Joints vs. BonesJoints are the places where two or more bones meet. Most of your joints are mobile and allow your bones to move.
Joints vs. Bones
Joints are the places where two or more bones meet. Most of your joints are mobile and allow your bones to move.
Osteomyelitis
According to the Cleveland Clinic, osteomyelitis affects 2 out of every 10,000 people.Osteomyelitis can affect both adults and children. With children, it usually affects thelong bonesof the arms or legs.For adults, it commonly affects the spine bones or the hip bones
Most cases of osteomyelitis are related to staph bacteria. Bacteria can enter the bone in different ways, including from:
Risk factors that may increase someone’s risk for osteomyelitis include:
Septic arthritis affects 2 to 10 per 100,000 people in the United States and Western Europe, according to a 2020 report in the journalBMC Infectious Diseases.It can affect anyone regardless of age or sex.
It occurs when bacteria, mycobacteria, or other organisms get into the synovial fluid of the joints and start to multiply and causeinflammation(swelling, tenderness, stiffness, etc.).
The three main types of bacteria that cause septic arthritis are staph, strep, and gonococci.The bacteria related to septic arthritis usually travels through the bloodstream.
People who have an increased risk for septic arthritis might include those who have these risk factors:
To distinguish between osteomyelitis and septic arthritis, a healthcare provider will rely on a variety of testing methods. This might include a physical exam, a medical history, blood tests, other lab work, imaging, and bone biopsies.
Distinguishing between the two conditions is usually not difficult as the location of the pain is different, as are imaging findings.
Your healthcare provider will ask about your medical history, review your symptoms, and complete a physical examination. With the physical exam, they will look for signs of tenderness, redness, and swelling in soft tissue and bones. Your practitioner may also request bloodwork, imaging, a needle aspiration, and/or a bone biopsy:
To diagnose septic arthritis, your healthcare provider will do a physical examination and ask you about your medical and symptom history. If they suspect septic arthritis, they may request further testing, including bloodwork, taking a sample of fluid from the affected joint, as well as imaging.
Early diagnosis of septic arthritis is important to prevent damage to affected joints.
Treatment for both osteomyelitis and septic arthritis usually involves antibiotics and surgical drainage of pus from an affected bone or joint. Early diagnosis and treatment can give people with the condition the best chance for a full recovery.
Delayed treatment, on the other hand, could lead to chronic osteomyelitis or permanent joint damage from septic arthritis.
Treatment for osteomyelitis focuses on treating the infection and preserving as much bone as possible. This includes treatment withantibiotics, surgery, or both.
Antibiotics will bring the infection under control and reduce the need for surgery. Initially, antibiotic therapy starts with an IV (through a vein) and then switches over to oral antibiotics. Antibiotic therapy needs to target the pathogen that has caused the infection.
Chronic osteomyelitis might require surgery to remove infected bone or tissue. This prevents the infection from spreading and getting to the point where amputation is the only treatment option. Surgery to remove affected tissue is usuallybone debridement(removing diseased bone) orreconstructive surgery.
Treatment for septic arthritis might also include draining pus from the affected joint. Pus buildup can damage the joints if left untreated.
Drainage can be done with a needle, tube, or surgery (a procedure called arthroscopic drainage).Pus may need to be drained two or more times to completely treat the affected joint and to remove bacteria.
Other treatment for osteomyelitis might include:
Both osteomyelitis and septic arthritis are preventable conditions.
The best way to prevent osteomyelitis is to keep the skin clean. If you or a child have a cut, especially a deep cut, wash the area completely.
If you have conditions like autoimmune arthritis or diabetes that might increase your risk for infection, it is important to manage the symptoms of those conditions effectively. Contact your healthcare provider at the first signs of infection, including fever or chills and swelling in the affected area.
Early treatment of acute osteomyelitis can prevent it from becoming a chronic problem.
Concurrent Osteomyelitis and Septic Arthritis
Osteomyelitis and septic arthritis can occur independently, or they can appear together. When these conditions coexist, one condition might be treated without knowledge of the second condition, leading to delayed treatment of the second condition.
A study reported in 2013 in theJournal of Pediatric Orthopaedicsreported on a chart review of 200 children with septic arthritis.Using CT, MRI, and bone scans, researchers found evidence that 72% of shoulder infections and 50% of elbow, hip, knee, or ankle infections were concurrent to osteomyelitis infections.
The researchers concluded that having confirmation of a second, concurrent infection could improve treatment outcomes. It could also mean reduced hospital stays, decreased need for surgical procedures, and the ability to limit additional or chronic infections or permanent damage.
A Word From Verywell
The outlook for both osteomyelitis and septic arthritis can be good if these conditions are treated early and aggressively. Most people will start to feel better and notice symptom improvement within 48 hours of starting treatment. But untreated osteomyelitis or septic arthritis can cause permanent bone or joint damage and could put your life at risk.
Ensure you see your healthcare provider if you experience bone or joint pain or swelling that has no known cause or if you experience other signs of these conditions, including fever and chills.
13 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Organization for Rare Disorders (NORD).Osteomyelitis.Cleveland Clinic.Osteomyelitis.Hindle P, Davidson E, Biant LC.Septic arthritis of the knee: the use and effect of antibiotics prior to diagnostic aspiration.Ann R Coll Surg Engl. 2012;94(5):351-355. doi:10.1308/003588412X13171221591015Corrado A, Donato P, Maccari S, et al.Staphylococcus aureus-dependent septic arthritis in murine knee joints: local immune response and beneficial effects of vaccination.Sci Rep. 2016;6:38043. doi:10.1038/srep38043Colston J, Atkins B.Bone and joint infection.Clin Med (Lond). 2018;18(2):150-154. doi:10.7861/clinmedicine.18-2-150Penn Medicine.What is bone infection (osteomyelitis)?Medline Plus.Osteomyelitis.Ferrand J, El Samad Y, Brunschweiler B, et al.Morbimortality in adult patients with septic arthritis: a three-year hospital-based study.BMC Infect Dis. 2016;16:239. doi:10.1186/s12879-016-1540-0Johns Hopkins Medicine.Septic arthritis.Lee H, Hwang D, Jeon M, et al.Clinical features and treatment outcomes of septic arthritis due to Mycobacterium massiliense associated with intra-articular injection: a case report.BMC Res Notes. 2016;9(1):443. doi:10.1186/s13104-016-2245-6Rao N, Ziran BH, Lipsky BA.Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg. 2011;127 Suppl 1:177S-187S. doi:10.1097/PRS.0b013e3182001f0f.Horowitz DL, Horowitz S, Barilla-LaBarca ML.Approach to septic arthritis.Am Fam Physician; 84(6):653-660.Montgomery CO, Siegel E, Blasier RD, Suva LJ.Concurrent septic arthritis and osteomyelitis in children.J Pediatr Orthop. 2013;33(4):464-7. doi:10.1097/BPO.0b013e318278484f
13 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.National Organization for Rare Disorders (NORD).Osteomyelitis.Cleveland Clinic.Osteomyelitis.Hindle P, Davidson E, Biant LC.Septic arthritis of the knee: the use and effect of antibiotics prior to diagnostic aspiration.Ann R Coll Surg Engl. 2012;94(5):351-355. doi:10.1308/003588412X13171221591015Corrado A, Donato P, Maccari S, et al.Staphylococcus aureus-dependent septic arthritis in murine knee joints: local immune response and beneficial effects of vaccination.Sci Rep. 2016;6:38043. doi:10.1038/srep38043Colston J, Atkins B.Bone and joint infection.Clin Med (Lond). 2018;18(2):150-154. doi:10.7861/clinmedicine.18-2-150Penn Medicine.What is bone infection (osteomyelitis)?Medline Plus.Osteomyelitis.Ferrand J, El Samad Y, Brunschweiler B, et al.Morbimortality in adult patients with septic arthritis: a three-year hospital-based study.BMC Infect Dis. 2016;16:239. doi:10.1186/s12879-016-1540-0Johns Hopkins Medicine.Septic arthritis.Lee H, Hwang D, Jeon M, et al.Clinical features and treatment outcomes of septic arthritis due to Mycobacterium massiliense associated with intra-articular injection: a case report.BMC Res Notes. 2016;9(1):443. doi:10.1186/s13104-016-2245-6Rao N, Ziran BH, Lipsky BA.Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg. 2011;127 Suppl 1:177S-187S. doi:10.1097/PRS.0b013e3182001f0f.Horowitz DL, Horowitz S, Barilla-LaBarca ML.Approach to septic arthritis.Am Fam Physician; 84(6):653-660.Montgomery CO, Siegel E, Blasier RD, Suva LJ.Concurrent septic arthritis and osteomyelitis in children.J Pediatr Orthop. 2013;33(4):464-7. doi:10.1097/BPO.0b013e318278484f
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
National Organization for Rare Disorders (NORD).Osteomyelitis.Cleveland Clinic.Osteomyelitis.Hindle P, Davidson E, Biant LC.Septic arthritis of the knee: the use and effect of antibiotics prior to diagnostic aspiration.Ann R Coll Surg Engl. 2012;94(5):351-355. doi:10.1308/003588412X13171221591015Corrado A, Donato P, Maccari S, et al.Staphylococcus aureus-dependent septic arthritis in murine knee joints: local immune response and beneficial effects of vaccination.Sci Rep. 2016;6:38043. doi:10.1038/srep38043Colston J, Atkins B.Bone and joint infection.Clin Med (Lond). 2018;18(2):150-154. doi:10.7861/clinmedicine.18-2-150Penn Medicine.What is bone infection (osteomyelitis)?Medline Plus.Osteomyelitis.Ferrand J, El Samad Y, Brunschweiler B, et al.Morbimortality in adult patients with septic arthritis: a three-year hospital-based study.BMC Infect Dis. 2016;16:239. doi:10.1186/s12879-016-1540-0Johns Hopkins Medicine.Septic arthritis.Lee H, Hwang D, Jeon M, et al.Clinical features and treatment outcomes of septic arthritis due to Mycobacterium massiliense associated with intra-articular injection: a case report.BMC Res Notes. 2016;9(1):443. doi:10.1186/s13104-016-2245-6Rao N, Ziran BH, Lipsky BA.Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg. 2011;127 Suppl 1:177S-187S. doi:10.1097/PRS.0b013e3182001f0f.Horowitz DL, Horowitz S, Barilla-LaBarca ML.Approach to septic arthritis.Am Fam Physician; 84(6):653-660.Montgomery CO, Siegel E, Blasier RD, Suva LJ.Concurrent septic arthritis and osteomyelitis in children.J Pediatr Orthop. 2013;33(4):464-7. doi:10.1097/BPO.0b013e318278484f
National Organization for Rare Disorders (NORD).Osteomyelitis.
Cleveland Clinic.Osteomyelitis.
Hindle P, Davidson E, Biant LC.Septic arthritis of the knee: the use and effect of antibiotics prior to diagnostic aspiration.Ann R Coll Surg Engl. 2012;94(5):351-355. doi:10.1308/003588412X13171221591015
Corrado A, Donato P, Maccari S, et al.Staphylococcus aureus-dependent septic arthritis in murine knee joints: local immune response and beneficial effects of vaccination.Sci Rep. 2016;6:38043. doi:10.1038/srep38043
Colston J, Atkins B.Bone and joint infection.Clin Med (Lond). 2018;18(2):150-154. doi:10.7861/clinmedicine.18-2-150
Penn Medicine.What is bone infection (osteomyelitis)?
Medline Plus.Osteomyelitis.
Ferrand J, El Samad Y, Brunschweiler B, et al.Morbimortality in adult patients with septic arthritis: a three-year hospital-based study.BMC Infect Dis. 2016;16:239. doi:10.1186/s12879-016-1540-0
Johns Hopkins Medicine.Septic arthritis.
Lee H, Hwang D, Jeon M, et al.Clinical features and treatment outcomes of septic arthritis due to Mycobacterium massiliense associated with intra-articular injection: a case report.BMC Res Notes. 2016;9(1):443. doi:10.1186/s13104-016-2245-6
Rao N, Ziran BH, Lipsky BA.Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg. 2011;127 Suppl 1:177S-187S. doi:10.1097/PRS.0b013e3182001f0f.
Horowitz DL, Horowitz S, Barilla-LaBarca ML.Approach to septic arthritis.Am Fam Physician; 84(6):653-660.
Montgomery CO, Siegel E, Blasier RD, Suva LJ.Concurrent septic arthritis and osteomyelitis in children.J Pediatr Orthop. 2013;33(4):464-7. doi:10.1097/BPO.0b013e318278484f
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