In suspected septic arthritis, what is the next step if purulence is found during joint aspiration?

• A. Proceed to irrigation and debridement.
• B. Switch to oral antibiotics only.
• C. Observe and discontinue treatment.
• D. Ignore Purulence.

Answer: (A)

Purulence in a suspected septic joint signals established infection that must be controlled immediately. The best next step is urgent irrigation and debridement of the joint to physically remove purulent material and infected tissue, reduce the bacterial load, and allow antibiotics to work effectively. This is typically done with rapid arthroscopic irrigation/debridement (or open debridement if needed), with cultures obtained at the time of the procedure. Start broad-spectrum intravenous antibiotics right away after obtaining cultures and tailor them once results return. Purulent drainage cannot be reliably treated with antibiotics alone taken by mouth, and delaying drainage risks rapid cartilage destruction and systemic spread.