septic arthritis

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   Our user asked: "Background: My mother has mild dementia and spent time in the hospital for a delirious episode (of unknown cause, possibly UTI or infection). Prior to this event she was independent and walked with a cane but she has severe osteo arthritis in her hips and knees. During her hospital stay she was confined to a wheelchair and rarely ambulated although at the beginning of her stay she could stand. At discharge, she went to a rehab/nursing facility to regain mobility (her confusion has persisted.) At the rehab, she was diagnosed with septic arthritis in her knee due to a staph infection. She may have had this in the hospital and it was not diagnosed (we were very disappointed with the care she received) or she may have picked it up there when they drained her knee - but either way, she had this infection for at least a week before it was detected and treated. My question is this: is it uncommon for a septic arthritis patient to have trouble standing? She does not seem to be able to lift herself from sitting and when assisted, does not bear weight on her knees (she keeps them bent). The PT thinks she has "plateaued" because she is unwilling or too demented to stand. The PT doesn't believe that my mother has any pain in her septic knee. I have tried to help her stand myself and she appears to be trying (she bears down on support with her arms and seems stressed by the effort). When I ask her she tells me she can't do it but will try later. It seems that after she refuses to stand her PT session ends and she is returned to her room. Also, she now has non-pitting edema of both legs and feet and her calfs are swollen and rock-hard. I believe she should not be written off and could still benefit from PT. At the very least, I believe that the septic arthritis and edema should be considered. What is your opinion?"

Ask a PT Response: "If your mother's prior level of function included your mother ambulating independently, than the therapist working with her should be working with her to achieve this goal. Severe OA of the hips and knees, along with septic arthritis can result in pain with standing. GIven the recent past medical history of your mother, it would not be uncommon for her to experience some degree of difficulty with standing and ambulating. Often times physical therapists would utilize parallel bars or an eva walker (walker that has a platform for the patient to lean on while standing) to assist a patient with bearing weight through the lower extremities while ambulating. They can also have patients perform exercises to work on strengthening, range of motion, etc. which can help with the preparation and transition to ambulating as well. I guess I would not give up on your mother yet."

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Ask a PT Members Profile Send Private Message Find Members Posts Add to Buddy List Senior Member Joined: Jul 07 2008 Status: Offline Points: 954	Post Options Post Reply Quote Ask a PT Report Post Thanks(0) Quote Reply Topic: septic arthritis Posted: Apr 21 2009 at 3:48pm
	Our user asked: "Background: My mother has mild dementia and spent time in the hospital for a delirious episode (of unknown cause, possibly UTI or infection). Prior to this event she was independent and walked with a cane but she has severe osteo arthritis in her hips and knees. During her hospital stay she was confined to a wheelchair and rarely ambulated although at the beginning of her stay she could stand. At discharge, she went to a rehab/nursing facility to regain mobility (her confusion has persisted.) At the rehab, she was diagnosed with septic arthritis in her knee due to a staph infection. She may have had this in the hospital and it was not diagnosed (we were very disappointed with the care she received) or she may have picked it up there when they drained her knee - but either way, she had this infection for at least a week before it was detected and treated. My question is this: is it uncommon for a septic arthritis patient to have trouble standing? She does not seem to be able to lift herself from sitting and when assisted, does not bear weight on her knees (she keeps them bent). The PT thinks she has "plateaued" because she is unwilling or too demented to stand. The PT doesn't believe that my mother has any pain in her septic knee. I have tried to help her stand myself and she appears to be trying (she bears down on support with her arms and seems stressed by the effort). When I ask her she tells me she can't do it but will try later. It seems that after she refuses to stand her PT session ends and she is returned to her room. Also, she now has non-pitting edema of both legs and feet and her calfs are swollen and rock-hard. I believe she should not be written off and could still benefit from PT. At the very least, I believe that the septic arthritis and edema should be considered. What is your opinion?" Ask a PT Response: "If your mother's prior level of function included your mother ambulating independently, than the therapist working with her should be working with her to achieve this goal. Severe OA of the hips and knees, along with septic arthritis can result in pain with standing. GIven the recent past medical history of your mother, it would not be uncommon for her to experience some degree of difficulty with standing and ambulating. Often times physical therapists would utilize parallel bars or an eva walker (walker that has a platform for the patient to lean on while standing) to assist a patient with bearing weight through the lower extremities while ambulating. They can also have patients perform exercises to work on strengthening, range of motion, etc. which can help with the preparation and transition to ambulating as well. I guess I would not give up on your mother yet."

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