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How to perform a joint flush in a dog with septic arthritis | VETgirl Veterinary Continuing Education Videos

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In this VETgirl online veterinary continuing education video, we demonstrate how to perform a joint flush in a dog with septic arthritis. While septic or infectious arthritis is rare, underlying causes include hematogenous spread, penetrating wound (e.g., dog bite), surgical wound or infection, intraarticular injections, infectious causes, etc. Treatment for septic arthritis consists of antibiotic therapy (e.g., enterally or parenterally, depending on how stable the patient is), joint flushing, and surgical treatment (to remove infected or necrotic tissue in severe cases).

Clinical signs of septic arthritis in the dog include inappetance, lethargy, lameness, joint swelling, hyperemia, pyrexia, murmurs, and generalized malaise. Clinicopathologic testing may reveal a leukocytosis with a left shift and a positive 4DX SNAP test or tick titers (e.g., Borrelia burgdorferi, Ehrlichia, Rocky Mountain spotted fever, etc.). Radiographs may reveal joint swelling, lysis, osteomyelitis, osteophytes, ankylosis of the joint, or degenerative joint disease (in chronic cases). A sterile joint tap (performed under sedation) should be performed for fluid analysis and culture of the synovial fluid prior to joint flushing, and may reveal purulent-appearing joint fluid.

To perform a joint flush in a dog with septic arthritis, the patient should be sedated once stable. Before beginning, make sure to have the appropriate supplies prepared including:

  • Surgical scrub and preparation of the joint site
  • Drape material
  • Sterile gloves
  • 2 sterile, 19 gauge needles (or larger, sterile metal cannulas, depending on the size of the patient)
  • 1 liter of sterile saline attached to an extension set
  • Aerobic and anaerobic culturettes for submission of joint fluid
  • An EDTA and red top tube for fluid analysis and cytology submission

Depending on the affected joint, a 19 gauge needle (or larger, sterile metal cannula) should be placed directly into the joint space. Thick, viscous synovial fluid should begin to drain immediately. An additional 19 gauge needle should be placed a few centimeters away (e.g., in this case, peripatellar) to the initial needle; synovial fluid should also drain from this needle. Using a pressure bag, the sterile saline and extension set should be attached to the more gravity-independent needle, allowing fluid to drain and flush out of the more gravity-dependent needle. The full liter should be used to lavage the joint. Once the joint is lavaged, both needles can be swiftly removed.

*NOTE: The use of strong concentrations of povidone-iodine or chlorhexidine should not be used for flush, as they can result in a chemical synovitis (Fossum).

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References:
1. Fossum TW, Hedlund CS, Hulse DA, et al., Eds. Small Animal Surgery: Management of Joint Disease. Mosby: St. Louis, 1997;891-892.

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