[Diagnosis and stage-related therapy of joint infections].

BACKGROUND: Our management of septic arthritis is a combination of a stage-related arthroscopic irrigation, debridement and antibiotic therapy. At the start of therapy x-rays of the infected joint, leukocyte rate with differentiation and C-reactive protein level are necessary and aspiration of the joint should be performed for gram strain and crystal analysis. Additional imaging and laboratory tests can be needed for special indications. An arthroscopic staging of the initial joint infection has been shown to have prognostic and therapeutic consequences. Antibiotic therapy should start after aspirates and biopsy specimen have been taken intraoperatively and has to be adapted to the final results of the microbiology. Overall, antibiotic therapy is necessary for a period of 4-6 weeks, unless clinical findings and laboratory tests have returned to normal. A transition to oral administration of antibiotics is possible prior to patient release. INTRAOPERATIVE TREATMENT: Intraoperatively, the synovial membrane should be left intact. There is no indication for the intra-articular use of antibiotics and antiseptics. Wound drains are not necessary. If symptoms of infection persist under antibiotic therapy, arthroscopic irrigation can be repeated with good results.