For the discussion on the hip we shall talk about septic arthritis (SA). SA is mostly common in the hip and knee, and rarely presents in the elbow or shoulder. Although it is rare in the archaeological record, it is nonetheless recorded in a number of examples (i.e. Yukon individuals in the Natural Museum of National History in Washington, US), and it pays to be able to recognise it (Roberts & Manchester 2010: 154). The condition is fairly uncommon, and the aetiology of SA is when an infection reaches a joint, normally through one of three means- i) the haematogenous route (most common), ii) a penetrating injury or iii) its spread from metaphysis (Marsland & Kapoor 2008). The bacteria, or germ, normally infects the synovial fluid which may be inflamed from disease or trauma, and ‘proliferation of bacteria cause an inflammatory response by the host with numerous leucocytes migrating into the joint’ (Marsland & Kapoor 2008: 136).
At this point the variety of enzymes and breakdown products that are produced helps to damage the articular cartilage very quickly, and if left will produce permanent damage (Waldron 2009: 89). The prognosis is good if treated promptly, however in the archaeological record this is quite unlikely due to the high risks of re-infection and complications such as joint destruction, avascular necrosis (mostly at the hip) & the ‘seeding of infection’ to other places (Marsland & Kapoor 2008: 137). Again, the diagnosis of septic arthritis in the archaeological record is hindered by confusion with similarities to tuberculous infection, and difficulties in diagnosing multiple diseases that may present themselves on any one individual (Roberts & Manchester 2010: 154). In the hip, the surface and surrounding area (lunate surface) of the acetabulum would be highly damaged, with a rough appearance and feeling as the bony lytic destruction took hold (Waldron 2009).
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