Bone AND Joint Infections

The answer first

Bone and joint infections span native joint septic arthritis, native vertebral and long-bone osteomyelitis, prosthetic joint infection, fracture-related infection, diabetic foot osteomyelitis, and the special situations of paediatric septic arthritis and the immunocompromised host. They share a common clinical imperative: a hot, swollen, painful joint or a painful long bone with systemic features is infection until proven otherwise, the diagnosis rests on synovial fluid or bone biopsy culture, and the management integrates surgical source control with prolonged organism-directed antibiotic therapy. The physician's task is to recognise the urgency, choose the diagnostic sample that changes therapy, initiate empirical antibiotics only after cultures are obtained (where possible), and coordinate with orthopaedics, infectious diseases, microbiology, and rehabilitation. ^{[1] [2] [4] [5]}

The FRACP candidate must be able to defend three positions without hedging: (1) an acutely hot joint is septic arthritis until proven otherwise, the diagnostic test is synovial fluid analysis (cell count, Gram stain, culture, crystal examination), and the management is urgent surgical washout plus antibiotics — delay risks irreversible cartilage destruction and systemic sepsis; (2) vertebral osteomyelitis (discitis) presents with progressive back pain, fever, and raised inflammatory markers, and is confirmed by MRI and image-guided biopsy; and (3) prosthetic joint infection requires a structured work-up (serum inflammatory markers, synovial cell count and culture, image-guided aspiration, intra-operative cultures) and a defined surgical strategy (debridement antibiotics and implant retention for early infection; one-stage or two-stage exchange for chronic infection; permanent suppressive antibiotics for patients unfit for surgery). Lead with the decision, then the evidence, then the trap. ^{[1] [2] [4]}

References8ShowHide

1. [1]Berbari EF, Kanj SS, Kowalski TJ, et al. 2015 Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines for the Diagnosis and Treatment of Native Vertebral Osteomyelitis in Adults. Clin Infect Dis, 2015.PMID 26229122
2. [2]Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013.PMID 23223583
3. [4]Mathews CJ, Weston VC, Jones A, et al. Bacterial septic arthritis in adults. Lancet, 2010.PMID 20206778
4. [5]Lipsky BA, Berendt AR, Cornia PB, et al. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis, 2012.PMID 22619242
5. [6]Mitrovic S, Delplanque M, Ea HK, Frémond ML, et al. Club Rhumatismes et Inflammation guidelines for anti-interleukin-1 therapy: 2026 update Joint Bone Spine, 2026.PMID 42276158
6. [10]Pallanza M, Ateschrang A, Boyd A, Conen A, et al. Nationwide, multicentre, prospective periprosthetic joint infection cohort study: study protocol of the Swiss Revision Cohort (REVCO) BMJ Open, 2026.PMID 42463213
7. [11]Li HK, Rombach I, Zambellas R, et al. Oral versus Intravenous Antibiotics for Bone and Joint Infection. N Engl J Med, 2019.PMID 30699315
8. [12]Fonkoué L, Tissingh EK, Marais LC, Malaba M, et al. Management of fracture-related infection in low-resource settings in Africa: recommendations and guidelines from an international expert group J Bone Jt Infect, 2026.PMID 42445811