Abstract : Spontaneous septic arthritis is a severe condition associated with the risk of joint destruction and systemic complications, with medical management frequently employed as the initial treatment approach. However, the necessity and timing of hyperacute surgical intervention remain subjects of debate. This meta-analysis systematically evaluated the comparative effectiveness of medical management versus surgical intervention for spontaneous septic arthritis. A comprehensive search of Google Scholar, MEDLINE, and Cochrane databases was conducted in accordance with PRISMA guidelines. Data were extracted from four comparative studies encompassing 273 participants, assessing complete recovery as the primary outcome, along with mortality and hospital length of stay as secondary outcomes. The findings indicate that patients managed medically had a 77% greater likelihood of achieving complete recovery compared to those undergoing surgical intervention (OR 1.77, 95% CI 1.01 to 3.08). While medical management was associated with a shorter hospital stay, this result did not reach statistical significance (MD -1.62 days, 95% CI -4.52 to 1.27). Mortality rates were comparable between the two treatment strategies (OR 1.17, 95% CI 0.44 to 3.07). These results suggest that medical management may offer superior recovery outcomes for patients with spontaneous septic arthritis without significant differences in mortality or hospital stay compared to hyperacute surgical intervention.