Aims. Septic arthritis of the hip often leads to irreversible osteoarthritis (OA) and the requirement for total hip arthroplasty (THA). The aim of this study was to report the mid-term risk of any infection, periprosthetic joint infection (PJI), aseptic revision, and reoperation in patients with a past history of septic arthritis who underwent THA, compared with a control group of patients who underwent THA for OA. Methods. We retrospectively identified 256 THAs in 244 patients following septic arthritis of the native hip, which were undertaken between 1969 and 2016 at a single institution. Each case was matched 1:1, based on age, sex, BMI, and year of surgery, to a primary THA performed for OA. The mean age and BMI were 58 years (35 to 84) and 31 kg/m. 2. (18 to 48), respectively, and 100 (39%) were female. The mean follow-up was 11 years (2 to 39). Results. The ten-year survival free of any infection was 91% and 99% in the septic arthritis and OA groups, respectively (hazard ratio (HR) = 13; p < 0.001). The survival free of PJI at ten years was 93% and 99% in the septic arthritis and OA groups, respectively (HR = 10; p = 0.002). There was a significantly higher rate of any infection at ten years when THA was undertaken within five years of the diagnosis of septic arthritis compared with those in whom THA was undertaken > five years after this diagnosis was made (14% vs 5%, respectively; HR = 3.1; p = 0.009), but there was no significant difference in ten-year survival free of aseptic revision (HR = 1.14; p = 0.485). The mean Harris Hip Scores at two and five years postoperatively were significantly lower in the septic arthritis group compared with the OA group (p = 0.001 for both). Conclusion. There was a ten-fold increased risk of PJI in patients with a history of septic arthritis who underwent THA compared with those who underwent THA for OA with a ten-year cumulative incidence of 7%. The risk of any infection had a strong downward trend as the time interval between the diagnosis of septic arthritis and THA increased, highlighted by a 3.1-fold higher risk when THAs were performed within five years of the diagnosis being made. Cite this article: Bone Joint J 2022;104-B(2):227–234

Aim. Septic arthritis of the hip is a rare entity among the adult population, but with a potential severe repercussion. The most accepted treatment is the hip debridement, even though a notorious proportion of the cases need further hip replacement owing to the cartilage destruction. The aim of this study is to analyse all our cases of septic arthritis of the hip treated with a 2-stage strategy using an antibiotic-loaded cement spacer. Method. We present a retrospective review of all our cases of septic arthritis of the hip diagnosed between 2004 and 2016 that were treated with an antibiotic-loaded cement spacer. We analysed age, gender, comorbidities, aetiology, duration of symptoms, C-reactive protein values, erythrocyte sedimentation rate, initial treatment, cultures, definitive treatment and evolution. Results. A total of 14 cases were included with a mean age of 47 years: 8 men and 6 women. The aetiology of the arthritis was: haematogenous in 8 cases, after osteosynthesis in 5 cases and after arthroscopy in 1 case. An initial debridement was performed in 6 cases whereas the spacer was directly implanted in 8 cases. The cultures were positive for: Staphylococcus aureus (4 cases), Candida albicans (2 cases), Staphylococcus epidermidis (1 case), Pseudomonas aeruginosa (1 case), Enterococcus faecium (1 case), Serratia marcescens (1 case), Streptococcus dysgalactiae (1 case), Salmonella spp (1 case) and negative in 2 cases. The evolution was: total hip arthroplasty in 10 cases, spacer preserved in 2 cases, pending of hip replacement in 1 case and exitus in 1 case. All cases presented negative cultures at the moment of implantation of the definitive prosthesis. Conclusions. A 2-stage strategy using an antibiotic-loaded cement spacer prior to the definitive hip prosthesis is a good treatment for the septic arthritis of the hip in cases with important cartilage destruction

Septic arthritis of the hip is the commonest joint infection and unfortunately the most devasting location. The most serious complication of the pyogenic arthritis of the hip in children and especially in newborns and infants is avascular necrosis of the femoral head which can lead to partial or complete destruction of the capital femoral epiphysis, the growth plate or both. The aim of the study was to evaluate the residual deformity after late treatment of septic arthritis of the hip in infancy. The present study included the review of 112 children under the age of 15 with bacteriologically proven septic arthritis of the hip in Prishtina University Hospital-Paediatric Orthopaedic Unit between September 1985 and January 2002. Their ages ranged from 7 days to 14 years, 72 boys and 40 girls with 112 involved hips. All underwent joint aspiration monitoring by real-time ultrasonography and fluid analysis including culture. On the anterior image the distance between the anterior outline of the femoral neck and the anterior joint capsule was measured in millimeters. The length of the follow-up was 3–20 years. Delay in Hospital admission was observed in 30 (27%) of patients. Eighty-two (73%) were admitted during the first week after onset of complaints. ESR was elevated initially in 87.5% of the cases. The mean ACD in hips with septic arthritis was 13.5mm (ST=0.75mm) and 3.9mm (ST=0.45 mm) in the asymptomatic hips. There was a significant difference in mean ACD for affected and unaffected sides. Complications were: one patient died from sepsis complications. In 14 patients (12.5%) there was destruction of the joint cartilage; pathological dislocation of the hip in 12 cases, 10 of whom were under the age of 6 years; also there were growth changes because of physeal arrest in 6 cases. Delay in diagnosis and failure to begin treatment promptly are the most common reason for late complication of infection. Poor prognostic factor was also the patient age if it was less than 1 year

Introduction: Septic arthritis of the hip joint in the pediatric age group is considered as an indication for surgical drainage of the joint. The commonly accepted treatment is arthrotomy of the hip joint, and continuous lavage and drainage. The child is treated with intravenous antibiotic therapy and is sometimes placed in a cast. Because of repeated technical problems with the drains, the senior author developed a method of treatment by repeated aspirations of the hip joint under ultra-sound guidance. We report the results of the first group of these patients, followed up for at least 2 years. Methods: Hip aspiration is performed when a child is suspected to have septic arthritis of the hip joint based on clinical, radiographic, ultrasonic and laboratory examinations. When hip effusion is found, aspiration is performed under ultrasound guidance, using topical anesthesia and strict sterile technique. If the aspirated fluid is visibly purulent, the joins is irrigated with sterile saline until clear fluid is aspirated. The patient is admitted to the hospital and intravenous antibiotic therapy is initiated. Repeated ultrasound examinations are performed daily, and the joint is decompressed and irrigated again. The procedure is continued until no effusion is demonstrated. Results: Twenty-four patients were treated for septic arthritis of the hip joint at our institution between January 1st 1990 and December 31st 1998. The first 3 patients were operated and then aspirated when the drains were clogged during the first post operative day. Twenty-one patients were treated by repeated aspirations. Four of those patients were operated when the aspiration failed or when the clinical course did not improve, all of them during the first 4 years of the study. Seventeen patients were treated by repeated aspirations only. The mean number of aspirations was 4, and the children tolerated them well. No complications were seen on follow-up, and all patients went back to full activities. No cases of avascular necrosis of the femoral head were identified. Discussion and Conclusions: Arthrotomy and drainage of hip joint is an emergency procedure for the treatment of septic arthritis of the hip joint. Possible complications of the procedure are dislocation of the hip joint, avascu-lar necrosis of the hip joint and technical problems with drains. We describe a reliable and safe procedure, that does not necessitate general anesthesia and surgery. The 4 patients who did have to undergo surgery represent a learning curve, and were all treated during the first four years. No complications or late sequelae were seen in our patients

Arthrotomy is considered the standard treatment for septic arthritis of the hip. This may be complicated by AVN or postoperative hip instability. Arthroscopic treatment of this condition is still not an established technique despite its minimally invasive nature and being associated with low morbidity. A three portal arthroscopic technique was used for drainage, debridment and irrigation in 13 patients with septic coxarthrosis. Continuous intraarticular irrigation was not performed, nor was decompression drains used. All patients were treated with intravenous antibiotics for three weeks, followed with oral antibiotics for an additional minimum of three weeks. The patients were followed for 1-7 years. Staphylococcus aureus was identified in four of the six patients. All patients had a rapid postoperative recovery. The mean Harris Hip Score at the last review was 97.5 points. All patients had a full range of motion of the affected hip. No complications occurred with this group of patients. Three directional arthroscopic surgery combined with large volume irrigation is an effective treatment modality in cases of septic arthritis of the hip. It is less invasive than arthrotomy, and offers low post surgical morbidity

Background: Arthrotomy is considered the standard treatment for septic arthritis of the hip. This may be complicated by AVN or postoperative hip instability. Arthroscopic treatment of this condition is still not an established technique despite its minimally invasive nature and being associated with low morbidity. Material and methods: A three portal arthroscopic technique was used for drainage, debridment and irrigation in 12 patients with septic coxarthrosis. Continuous intraarticular irrigation was not performed, nor was decompression drains used. All patients were treated with intravenous antibiotics for three weeks, followed with oral antibiotics for an additional minimum of three weeks. Results: The patients were followed for 1–7 years. Staphylococcus aureus was identified in four of the six patients. All patients had a rapid postoperative recovery. The mean Harris Hip Score at the last review was 97.5 points. All patients had a full range of motion of the affected hip. No complications occurred with this group of patients. Interpretation: Three directional arthroscopic surgery combined with large volume irrigation is an effective treatment modality in cases of septic arthritis of the hip. It is less invasive than arthrotomy, and offers low post surgical morbidity

1. Septic arthritis of the hip in adults is not common and the diagnosis can be difficult. The value of diagnostic aspiration is emphasised. 2. Predisposing causes in fifty patients are analysed and the possible relationship to pelvic infection is discussed. 3. Loss of joint space is occasionally seen within one week of the onset of the infection. 4. A method of treatment is suggested and the value of decompression by arthrotomy is discussed

Septic arthritis of the hip remains a serious problem in our environment. The diagnosis is difficult and treatment is challenging. Particularly in patients presenting late, the outcome may be poor. From January 1998 to December 2002, 27 children were admitted to the paediatric unit with the diagnosis of septic arthritis. Their ages ranged from 2 to 12 years and the duration of symptoms ranged from 3 days to 3 months. Pain, fever and a limp were the main clinical features. Only one child had bilateral involvement. Laboratory investigations revealed Staphylococcus in 20 children, Serratia in one, Pseudomonas in one and Haemophilus influenza in one. In four patients no growth was identified. Initial radiological findings ranged from no abnormalities in 18 children, to capsular distention in six and hip dislocation in three. Ultrasonography, CT scan and bone scan were also performed. All patients underwent surgical exploration. Twelve had septic arthritis, six pelvic osteomyelitis and five proximal femoral osteitis. There were two psoas abscesses, a buttock abscess and a case of inguinal lymphadenitis. Follow-up ranged from 3 months to 5 years. Only eight children had a good outcome and full range of movement. There were six cases of ankylosis, 10 of avascular necrosis and three of dislocation. Thorough clinical and radiographic examination is advocated in patients with apparent septic arthritis, as misdiagnosis is common. The infection may be in the pelvis, femoral neck or related soft tissues

Two-stage revision arthroplasty is the gold standard for treatment of infection after total hip Arthroplasty and end stage septic arthritis of the hip. In the first stage we used a modified technique to insert an inexpensive modular femoral component coated with antibiotic-impregnated polymethylmethacrylate articulating with a polyethylene liner. The construct was used in 8 patients with infected arthroplasty, and 6 patients with septic arthritis of the hip. Two patients were excluded (no second stage). Of the remaining 12 patients, only one patient had persistent infection after the first stage; 11 patients received a successful re-implantation at the second-stage. The technique provide a construct that can be used safely and successfully in the awaiting period between the two stages of revision arthroplasty

We performed 52 total hip replacements in 52 patients using a cementless acetabular component combined with a circumferential osteotomy of the medial acetabular wall for the late sequelae of childhood septic arthritis of the hip. The mean age of the patients at operation was 44.5 years (22 to 66) and the mean follow-up was 7.8 years (5 to 11.8). The mean improvement in the Harris Hip Score was 29.6 points (19 to 51) at final follow-up. The mean cover of the acetabular component was 98.5% (87.8% to 100%). The medial acetabular wall was preserved with a mean thickness of 8.3 mm (1.7 to 17.4) and the mean length of abductor lever arm increased from 43.4 mm (19.1 to 62) to 54.2 mm (36.5 to 68.6). One acetabular component was revised for loosening and osteolysis 4.5 years postoperatively, and one had radiolucent lines in all acetabular zones at final review. Kaplan-Meier survival was 94.2% (95% confidence interval 85.8% to 100%) at 7.3 years, with revision or radiological loosening as an end-point when two hips were at risk. A cementless acetabular component combined with circumferential medial acetabular wall osteotomy provides favourable results for acetabular reconstruction in patients who present with late sequelae of childhood septic hip arthritis

Introduction: There is a paucity in the literature regarding the long term outcome of children with septic hips. Often, there is a delay in diagnosis which may lead to complications such as growth arrest, deformity and leg length discrepancy. We investigated the outcome of these patients and report the observed complications. Methods: We performed a retrospective review of all children who underwent arthrotomy and washout for septic arthritis of the hip over a ten year period. Patients were identified from hospital databases and the coding department. Medical records were reviewed and data including demographics, method of presentation, laboratory investigations and outcome were recorded. Results: We analysed the records of 70 patients who underwent formal arthrotomy and washout of their septic hip. Two patients had bilateral washouts (n = 72 hips). There were 36 (51%) female patients. 24 patients were under 1 year of age at presentation, with 11 of these in the neonatal period. Temperature data was available for 48 patients, with a mean of 38.2 degrees Celsius at presentation. The mean ESR was 55.8. 28 patients (40%) grew an organism on culture of the hip fluid. The most common organism was Staphylococcus Aureus (64% of positive cultures). 66% (n=16) of patients in the < 1 year old group developed complications relating to growth arrest and leg length discrepancy. Seven of these patients (43%) underwent further surgery to correct deformity at a later date. In contrast, only 4.3% of patients in the > 1 year old group developed complications. The mean delay to surgery in patients who developed complications was 6.3 days with a mean delay to surgery of 3.1 days in patients who did not develop complications (p = 0.03, student’s T-Test). Discussion: Paediatric Septic Arthritis remains a complex issue for both the patient and the surgeon. We have demonstrated that an increased delay in patients undergoing washout can lead to increased complications although this predominantly affects patients under 1 year of age. This can be explained by the lack of clinical signs in a < 1 year old child. Clinicians should have a high index of suspicion of septic arthritis in patients with features of sepsis with an unknown cause

Introduction: Septic arthritis of the hip is an Orthopaedic emergency. While common in the paediatric population, it is rare in adults and little is reported on it. Methods: Retrospective review of cases presenting to Leeds General Infirmary, St James’s University Hospital & York District Hospital over a fourteen year period from 1991–2005. Results: 46 cases identified. The mean age was 43 years and 80% (37/46) of cases were male. Risk factors for sepsis were present in 87% (40/46) and consisted of IVDU in 48% (22/46), DM in 20% (9/46), liver disease in 22% (10/46) and immunosuppressive drugs in 17% (8/46). Rheumatic joint disease was present in 28% (13/46) consisting of rheumatoid arthritis, gout and psoriatic arthropathy in 13% (6/46), 9% (4/46) and 7% (3/46) respectively. The primary sources of sepsis were IVDU in 48% (22/46), unknown in 39% (18/46), line sepsis in 11% (5/46) and psoas abscess in 2% (1/46). All cases presented with the triad of groin pain, constitutional upset and difficulty or inability to weight bear. Examination revealed pyrexia in 57% (26/46) and a painfully decreased range of joint motion in all cases. Laboratory tests revealed a raised white cell count in 57% (34/46) and raised CRP’s and ESR’s in all cases. The most commonly isolated organism was staphylococcus aureus 78% (36/46). Medical treatment consisted of antimicrobial therapy for a mean length of 49 days. Surgical treatment consisted of a mean of 1.8 arthrotomies or arthroscopic hip washouts and debridements in consenting cases- 89% (41/46). Two stage total hip arthroplasty for symptom control was required in 4% (2/46). Outcomes were good with sepsis related mortality of 4% (2/46) and local recurrence of 9% (4/44). Discussion: Septic arthritis of the hip is a potentially serious condition. Timely medical and surgical intervention can lead to good outcomes

In order to assess the incidence of avascular necrosis (AVN) following septic arthritis of the hip in children, we retrospectively reviewed the outcome of 227 hips with septic arthritis treated over an 18-year period. The mean age at presentation of the 221 patients, six of who had bilateral conditions, was 5.6 years (5 months to 14 years). All patients underwent open arthrotomy and pus was found at surgery. Patients were treated with cloxacillin and patients aged six months to two years also received ampicillin. Staphylococcus areus was cultured in 51% of hips, Haemophilus influenzae in 9%, Streptococcus pneumoniae in 4% and Streptococcus pyogenes in 6%. The remaining 30% had no growth. Septicaemia was present in 20 patients at presentation. AVN developed in 24 hips (10.5%), and chondrolysis in five (2.2%). Of the hips with AVN, seven were septicaemic. The most important factor in the development of AVN was a delay of five or more days from onset of symptoms to surgery. The risk of AVN with five days’ delay was 50% and increased exponentially with a longer delay. Septicaemia did not constitute a risk per se, but did contribute to a delay in diagnosis of hip involvement. The total head was involved in 14 of the 24 hips with AVN, while 10 had partial head involvement, with a better long-term outcome

We present a case of septic arthritis of the hip caused by Candida albicans in a 24-year-old woman. This is the first report of a Candida infection of the hip in a patient without any predisposing factors. She underwent a two-stage total hip arthroplasty three years after the onset of the infection. An elevated plasma level of β-D-glucan suggested Candida as the infecting organism and the diagnosis might have been made earlier if this test had been undertaken at presentation

A series of ten infants is reported, seven of whom showed evidence of osteomyelitis of the upper end of the femur; the remaining three did not, but presented with an acute subluxation of the hip in a febrile illness. Four sequelae among the seven more severe cases were: 1) destruction of the capital epiphysis with dislocation at the hip; 2) destruction of the capital epiphysis, the femoral neck remaining in the acetabulum; 3) destruction of the epiphysial plate with the femoral head, remaining in the acetabulum, connected to the femoral neck by a fibrous union; 4) recovery with coxa magna but no other deformity.

The streptococcus plays a greater part in this osteomyelitis of infancy than in osteomyelitis of older children, but various other organisms were identified. The organism should be sought by blood culture as well as from the local lesion.

Aspiration of the hip, treatment of the hip in abduction and the use of the appropriate antibiotic are recommended. If there is marked swelling and induration, freer release of the pus is strongly advised.

Controlled abduction osteotomy plays a useful part in stabilising the femoral neck in the acetabulum or in stabilising the femoral neck beneath the capital epiphysis, but may usefully be preceded by an arthrograph because late ossification of a detached head sometimes occurs.

Aim: To study the epidemiology, diagnostic criteria and outcome of Septic Arthritis (SA) of hip in infancy and childhood. Method: Retrospective case notes review of 43 cases of Primary SA of hip. Diagnostic criteria used: 1. Confirmed SA: positive joint fluid culture/positive blood culture and elevated WCC in joint fluid / radiological changes. 2. Presumed SA: Negative cultures but elevated WCC in joint fluid. The outcome was rated as A. Satisfactory: clinically and radiology normal hip. B. Unpredictable: clinically normal hip with radiological changes. C. Unsatisfactory: clinically abnormal hip. Results: We had 37 cases of confirmed SA and 6 cases of presumed SA. Mean age of presentation was 4 years with male to female ratio of 3:2. All cases had either joint aspiration or arthrotomy. The 25% of cases with negative joint fluid cultures had a history of recent antibiotic use. Radiological changes were found in 40% cases. Mean duration of follow up was 33 months. Outcome was rated as satisfactory in 61%, unsatisfactory in 7% and unpredictable in 31%. Of confirmed SA cases 57% had a satisfactory outcome. The delay in the initial presentation was more than a week in all cases with unsatisfactory results. Conclusions: Our study outlines the demographic and microbiological profile of SA of the hip in children. Diagnosis in culture negative cases can be challenging, especially with a history of recent antibiotic use. Prolonged initial delay in presentation was associated with unsatisfactory outcomes

This paper could not be resubmitted: The paper was initially presented at the BHS and they have already published it in the JBJS Supplement.

Aim: To audit the impact of emergency hip ultrasound in the management of suspected hip septic arthritis. Methods and Results: Case series – Review of 13 consecutive patients who presented with acute hip pain, where clinical examination and inflammatory markers, highly suspicious of Septic arthritis. Emergency ultrasound was only available in 9 patients. Only 5 (38%) of these 13 patients had septic arthritis. Septic arthritis group. – Emergency ultrasound unavailable in 2 patents. They proceeded straight to arthrotomy yielding pus. – 3 had a preoperative ultrasound which confirmed the hip joint had an effusion. “Non Septic Arthritis of Hip” (8 patients). – In 2 patients emergency ultrasound unavailable. They underwent emergency arthrotomy with negative findings of pus. – 1 actually had septic arthritis of knee. – 6 patients did have emergency ultrasound which showed no effusion. Emergency arthrotomy was cancelled. – They proceeded to MRI of Hip. MRI revealed pathology close to but not involving the hip:. Pelvic osteomyelitis,. Psoas abscess,. Gluteal abscess secondary to small bowel fistula. Cellulitis of medial thigh. Femoral Epiphysis osteomyelitis. and inflammation of tendon secondary to line insertion. Inflammation of rectus femoris tendon (secondary to central line insertion). Conclusion: Use of ultrasound avoided unnecessary arthrotomy in 6 patients (48%). If ultrasound was available in all cases, then 8 (63%) patients would have avoided an unnecessary arthrotomy. Out of hours urgent hip ultrasound may be difficult to request. However our recent experience leads us to propose that if available ultrasound should be performed in all suspected case of hip septic arthritis prior to surgical drainage. Pathology in the vicinity of the hip can often masquerade convincingly as a septic hip joint

Aim. Septic arthritis is a painful infection of articular joints that is typically treated by irrigation & debridement along with antibiotic therapy. There is debate amongst the medical community whether antibiotic administration should be delayed until fluid cultures have been taken to improve culture yield. However, delaying antibiotics can also have negative consequences, including joint destruction and sepsis. Therefore, the purposes of this study were to determine: 1) whether delayed antibiotic treatment affects culture yield and prognosis and 2) if the culture yield of patients treated for septic arthritis differs for hip, knee, and shoulder based on timing of antibiotic administration. Method. A retrospective analysis was conducted on 111 patients with septic arthritis of the hip, knee, or shoulder admitted from 3/2016 to 11/2018. In patients with multiple septic joints, each joint was analyzed individually (n=122). Diagnosis was determined by the treatment of irrigation & debridement and/or a positive culture. Patients without all intervention times recorded or with periprosthetic joint infection were excluded. Demographics, laboratory tests, culture results, and intervention times were obtained through chart review. Patients were grouped based on antibiotic therapy timing: >24 hours prior to arthrocentesis (Group 1), between 24 hours and 1 hour prior (Group 2), and 1 hour prior to post-arthrocentesis (Group 3). Analysis was conducted using chi-squared tests. Results. The mean age of each group were similar: Group 1 (n=38) 55.7 years, Group 2 (n=20) 57.2 years, and Group 3 (n=64) 54.8 years. No difference was observed in culture sensitivity between groups (p=0.825) with 71.1% (27/38) positive cultures in Group 1, 75% (15/20) in Group 2, and 76.6% (49/64) in Group 3. Similarly, frequency of related readmissions within 90 days (p=0.863) did not significantly vary: 26.3% (10/38) in Group 1, 20% (4/20) in Group 2, and 25% (16/64) in Group 3. Additionally, there were no significant differences in culture sensitivity in the knee (p=0.618; Groups: 87.5%, 75%, 70.6%), shoulder (p=0.517; Groups: 77.8%, 66.7%, 90%), and hip (p=0.362; Groups: 61.9%, 80%, 80%). Conclusions. Culture sensitivities and rates of readmission were similar for all patients regardless of antibiotic administration timing. These results suggest that antibiotic administration should not be delayed in septic arthritis to improve culture yield. However, the data does not suggest that early antibiotic administration will result in better clinical outcomes by lowering readmission rates. Further research is needed to better determine the clinical benefits that early administration of antibiotics may have on patient outcomes

Aims. The aims of this study were to: 1) report on a cohort of skeletally mature patients with native hip and knee septic arthritis over a 14-year period; 2) to determine the rate of joint failure in patients who had experienced an episode of hip or knee septic arthritis; and 3) to assess the outcome following septic arthritis relative to the infecting organism, whether those patients infected by Staphylococcus aureus would be more likely to have adverse outcomes than those infected by other organisms. Methods. All microbiological samples from joint aspirations between March 2000 and December 2014 at our institution were reviewed in order to identify cases of culture-proven septic arthritis. Cases in children (aged < 16 years) and prosthetic joints were excluded. Data were abstracted on age at diagnosis, sex, joint affected (hip or knee), type of organisms isolated, cause of septic arthritis, comorbidities within the Charlson Comorbidity Index (CCI), details of treatment, and outcome. Results. A total of 142 patients were confirmed to have had an episode of septic arthritis in a native hip (n = 17) or knee joint (n = 125). S. aureus accounted for 57.7% of all hip and knee joint infections. There were 13 inpatient deaths attributed to septic arthritis. The median age of the patients who died was 77.5 (46.9 to 92.2) and their median age-adjusted CCI was 8 (6 to 12). A failure of the joint occurred in 26 knees (21%) and nine hips (53%). Of the knee joints infected by S. aureus (n = 71), 23 knees (32%) went into failure of joint, whereas of those infected by other organisms (n = 54), only three knees (6%) failed. Conclusion. Based on our study findings, hip and knee septic arthritis long-term outcomes were substantially worse than their immediate outcome suggested. Failure of knee joint is 6.1 times more likely to occur in those infected with S. aureus. Cite this article: Bone Jt Open 2024;5(9):785–792