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Objectives: Septic arthritis is an orthopedic surgical emergency. Repeat cultures increase cost and patient discomfort; however, it is unknown whether repeat cultures have any merit in guiding treatment. The primary purpose of this investigation is to determine if repeat septic arthritis synovial fluid cultures alter antibiotic management. The secondary purpose is to identify independent risk factors that may alter subsequent antibiotic therapy. Methods: Septic arthritis cases were retrospectively reviewed using the International Classification of Diseases, Ninth Revision codes between January 2011 and December 2015. Inclusion criteria were patients >18 years with >1 positive synovial culture taken >2 days apart. Results: Two hundred and ninety-two synovial cultures were taken. Seventy were repeat cultures. Around 3 quarters (74.3%) yielded the same bacteria and 25.7% yielded different bacteria. Less than half (45.7%) of repeat cultures were associated with a change in antibiotics. Of the 18 repeat cultures that yielded different bacteria, six repeat cultures contained the same bacteria ± a different organism. Thirteen of the eighteen repeat cultures with different bacteria required a change in antibiotics. Patients who had their antibiotic therapy changed after repeat cultures were more likely to have diabetes mellitus (66.7% vs. 38.5%; P = 0.04, OR = 3.2 [1.04, 9.89]). Patients with hepatitis C more frequently required a different antibiotic regimen on repeat cultures (69.2% vs. 40.4%; P = 0.06, OR = 3.3 [0.91, 12.1]). Conclusion: Repeat culture data in patients with septic arthritis changed antibiotic regimens in 45.7% of patients and yielded different bacteria in 25.7%. Patients with diabetes more frequently required alternate antibiotic regimens.

Background: A known complication following autologous chondrocyte implantation (ACI) for the repair of cartilage defects is graft hypertrophy. Although hypertrophic tissue can sometimes be asymptomatic, it may cause pain, catching, or effusion prompting a debridement operation—the most common cause for reoperation. Indications: Second-look arthroscopy is required for debridement of symptomatic hypertrophic or delaminated tissue. Technique Description: First, the graft is distinguished from the surrounding tissue. Visually, the graft has a lighter white color than the surrounding egg-shell-colored native cartilage. With a probe, it can be appreciated that the graft also has a softer texture than the firmer surrounding cartilage. Once the graft is identified, hypertrophy can be appreciated by the extent of raised margins from the surrounding cartilage. Delamination can also be seen by visualizing separated strands of graft on the surface or separation of the graft at the margins. A probe may then be used to gently assess the extent of the delamination. After diagnosing hypertrophy or delamination, a shaver is used to gently debride the tissue back so that it becomes flush with the surrounding tissue. Special care must be taken as to not over-debride the tissue, as this can subsequently lead to recurrent cartilage defect. Results: Patients are expected to have resolved pain, catching, and clicking sensations as well as resolved graft-associated effusion following this procedure. Discussion/Conclusion: Due to the incidence of symptomatic graft hypertrophy and delamination following ACI, second-look arthroscopy may be necessary to evaluate and possibly treat a cartilage defect following its repair. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.