Pyarthrosis
| Classification according to ICD-10 | |
|---|---|
| M00.- | Purulent arthritis |
| M01.- | Direct joint infections in infectious and parasitic diseases classified elsewhere |
| ICD-10 online (WHO version 2019) | |
Pyarthros , from ancient Greek πύον pyon , German 'pus' and ancient Greek. ἄρθρον arthron , German for joint , is an accumulation of pus in a joint due to a bacterial infection .
Synonyms are: pyarthrosis; Joint empyema; Purulent synovitis; Septic arthritis.
root cause
For local joint infection (primary form) the following are possible:
- Joint wounds, bursitides or skin infections, panaritia
- open fractures , injury with joint opening
- Subsidence abscesses (hip joint)
- Joint puncture, arthroscopy , surgery
- Postoperative hemarthrosis or hematoma
- Implant with secondary infections
In the case of hematogenous joint infection (secondary form), the following are found:
- In children, staphylococci or Haemophilus influenzae , Kingella kingae , Neisseria or Salmonella .
- In adults, Neisseria, Staphylococcus aureus , streptococci , enterobacteria , Moraxella osloensis , Streptobacillus moniliformis , mycobacteria
- Gram- negative bacteria are more common in immunocompromised patients
classification
Based on the pathological-anatomical changes , a distinction can be made:
- Stage I: joint empyema, only the inside of the joint inflamed
- Stage II: capsule-ligament phlegmon or panarthritis, also inflamed joint capsule and possibly adjacent soft tissues
- Stage III: osteoarthritis , inflammation down to the bones near the joint
According to the clinical findings , a distinction can be made:
- Stage I (purulent synovitis): joint swollen, skin red, shiny and overheated
- Stage II (joint empyema): increased swelling and reddening, severe pain, tenderness over the capsule, relieving posture, fever
- Stage III (panarthritis): massive soft tissue swelling, extreme pain, high fever
- Stage IV (chronic arthritis): minor signs of inflammation, deformation and diffuse swelling, fistula or scarring , severe functional impairment
On the basis of an arthroscopy :
- Stage I: slightly cloudy effusion, reddened synovium, possibly petechial bleeding
- Stage II: pronounced synovitis, fibrin exudation, purulent effusion
- Stage III: villi formation, chambering, formation of a so-called "bath sponge"
- Stage IV: Synovial membrane grows infiltrating into the cartilage and undermines it, radiologically already erosions, subchondral lightening, cyst formation
Differential diagnosis
The following are to be distinguished:
- Reactive arthritis (without evidence of pathogens in the joint) after bacterial or viral infections
- postoperative joint irritation
- Hemarthrosis
- Meniscus or articular cartilage disease
- Rheumatoid arthritis
- Activated osteoarthritis
- Chronic polyarthritis
- gout
- Necrotizing fasciitis
- Joint or intra-articular fractures
- Acute vein thrombosis
- Bursitis
- hemophilia
- Loosening an artificial joint
- Soft tissue and bone tumors near the joints
- Allergic synovitis (food, medication)
literature
- W. Lungershausen, E. Markgraf u. a .: joint empyema. In: The surgeon. 69, 1998, p. 828, doi: 10.1007 / s001040050497
- JS Parisien: Arthroscopic management of pyarthrosis. An overview. In: Bulletin of the Hospital for Joint Diseases Orthopedic Institute. Vol. 47, No. 1, 1987, pp. 52-57, PMID 3038227 .
Individual evidence
- ↑ Lexicon Orthopedics
- ↑ a b c Entry on Pyarthros in the Flexikon , a Wiki of the DocCheck company
- ↑ a b c guidelines
- ↑ F. Draijer, T. Lorentzen, R. Nissen, D. Havemann: The functional treatment of the operated knee joint empyema. In: The trauma surgeon. Vol. 97, No. 5, May 1994, pp. 273-277, PMID 8052866 .
- ↑ EH Kuner, HU Thürck, I. von der Lippe: ur diagnosis and therapy of acute knee joint infections . In: Trauma Surgery. Vol. 13, No. 5, October 1987, pp. 249-254, PMID 3424456 .
- ↑ A. Gächter: The importance of arthroscopy in Pyarthros. Trauma medicine. in: Unfallheilkunde , Vol. 200, 1988, pp. 132-36.
