When should I consider referring a patient with septic arthritis to an orthopedic specialist?

Consider referring a patient with septic arthritis to an orthopaedic specialist urgently if:

• There is suspicion or confirmation of septic arthritis, as immediate specialist input is required for diagnosis and management, including possible surgical intervention.
• The patient is seriously ill or has severe infection involving the joint, surrounding soft tissue, or skin necrosis, which may require surgical drainage or debridement.
• There is persistent infection despite appropriate antibiotic treatment, or infection with difficult-to-treat organisms (e.g., fungi), sepsis, underlying osteomyelitis, abscess, fistula, or foreign body involvement.
• Aspiration or surgical drainage is needed but expertise is not available in primary care.
• The patient is immunocompromised or has systemic signs of infection requiring hospital admission and intravenous antibiotics, with orthopaedic input for joint management.

In summary, urgent referral to orthopaedics is indicated when septic arthritis is suspected or confirmed, especially if there is severe infection, failure to respond to antibiotics, or need for surgical intervention ¹,²,³.