70 year old female with hot painful knee

1. Synovial fluid aspirate shows turbid fluid with large amount of leucocytes (predominantly polymorphs). A septic knee must be excluded.

Minimally traumatic

2.

Septic arthritis – partially treated

Exacerbation of chronic arthropathy

Reactive arthritis

Crystal arthropathy – gout/ pseudogout

Psoriatic Arthritis

Trauma

3.

Main complaint and history thereof – pain severity, type, radiation, analgesia taken, previous surgery/ septic joints

Precipitating factors – trauma, recent procedure

Risk factors – travel, immune-compromise, (sexual, IVDU)

Systemic upset and complications – sepsis

Social history – can the patient cope at home

4.

Synovial fluid – crystals, microscopy, culture

XRay

Blood:

– Infection screen – WCC, CRP/ ESR

– uric acid

– Ca/Mg

– renal function

– septic screen – other source of fever including CXR, urine MCS/gonorrhoea/Chlamydia, blood cultures as indicated etc

5. Next steps

Analgesia

Explanation to patient

depending on clinical impression – Orthopaedic consult vs conservative management