Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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An infected native joint needs urgent drainage
Purulent synovial inflammation rapidly damages cartilage and can seed blood or adjacent bone; older, immunosuppressed or prosthesis-free patients may have muted fever and inflammatory markers despite destructive infection.
Action: Assess for sepsis and obtain blood cultures, involve orthopaedics immediately, aspirate the joint before antibiotics when the patient is stable and this causes no delay, start protocol intravenous therapy after sampling or immediately in sepsis, and arrange emergency arthroscopic or open washout by an experienced team, targeting surgery within six hours when acutely unwell and safe.
Synopsis
Identify native-joint infection as a cartilage and sepsis emergency, aspirate correctly without delaying antibiotics in an unstable patient, distinguish crystals from exclusion, drain infected synovium promptly, and verify clinical and microbiological response.
Suspect septic arthritis with acute severe joint pain, restricted active and passive movement and an effusion, but recognise that fever and inflammatory markers may be absent.
Run the sepsis pathway and obtain at least two blood-culture sets. In shock or high-risk sepsis, start intravenous antibiotics immediately after cultures and never delay for aspiration.
In a stable patient, aspirate before antibiotics using sterile technique and image guidance for a deep or difficult joint; record volume, appearance and any preceding antimicrobial exposure.
Key red flags
A hot painful joint with severe movement restriction, systemic toxicity, hypotension, confusion or lactate elevation requires immediate sepsis and orthopaedic action rather than waiting for clinic aspiration results.
Investigation priorities
01
First-line urgent joint aspirationFirst stepFirst line
Obtain direct microbiological and inflammatory evidence before antibiotics when stable.
02
First-line plain radiographsFirst line
Identify fracture, foreign body, gas, chronic joint destruction and a baseline for follow-up.
Management branches
UnstableTreat sepsis and drain
A suspected infected joint accompanies shock, organ dysfunction or high-risk sepsis.
Obtain blood cultures without delaying treatment, start sepsis resuscitation and protocol broad-spectrum intravenous antibiotics immediately.
Call orthopaedics, anaesthesia and microbiology together and plan emergency drainage by an experienced team within six hours when safe.
StablePreserve culture then control source
Septic arthritis is suspected without current sepsis or organ compromise.
Key medicines
Empiric intravenous therapy after diagnostic culturesIn a stable adult, start the current trust septic-arthritis regimen immediately after blood and synovial cultures; in sepsis, give full protocol doses after blood cultures without waiting for aspiration, then narrow as soon as organism and susceptibilities permit.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.