Background Native joint septic arthritis (NJSA) is poorly studied. We describe the epidemiology, treatment, and outcomes of large joint NJSA (LNJSA) and small joint NJSA (SNJSA) in adults at Middlemore Hospital, Auckland, New Zealand. Methods This was a coding-based retrospective study of patients ≥16 years old admitted between 2009 and 2014. Prosthetic joint infections were excluded. Results Five hundred forty-three NJSA episodes were included (302 LNJSA, 250 SNJSA). Only 40% had positive synovial fluid culture. Compared to SNJSA, LNJSA has higher incidence (13 vs 8/100 000 person-years [PY]), occurs in older, more comorbid patients, and is associated with greater rates of treatment failure (23% vs 12%) and mortality, despite longer antibiotic treatment. Total incidence is higher than previously reported (21/100 000 PY), with marked interethnic variation. Incidence rises with age (LNJSA only) and socioeconomic deprivation (LNJSA and SNJSA). Tobacco smokers and males are overrepresented. The most commonly involved joints were knee (21%) and hand interphalangeal (20%). Staphylococcus aureus was the most common pathogen (53%). Mean antibiotic duration was 25 days for SNJSA and 40 days for LNJSA, and the mean number of surgical procedures was 1.5 and 1.6, respectively. Treatment failure was independently associated with LNJSA, age, intra-articular nonarthroplasty prosthesis, and number of surgical procedures. Conclusions This is the largest contemporary series of adult NJSA. SNJSA has better outcomes than LNJSA and may be able to be safely treated with shorter antimicrobial courses. Incidence is high, with significant ethnic and socioeconomic variation. Microbiological NJSA case ascertainment underestimates case numbers as it frequently excludes SNJSA.

BackgroundFight bite-related septic arthritis (FBSA) occurs when a joint is infected following a human bite injury. We aimed to describe the clinical features, treatment, and outcomes of FBSA and compare these with native joint septic arthritis of other causes.MethodsCases were obtained from a previously described retrospective cohort of adult native joint septic arthritis admitted to Middlemore Hospital, Auckland, New Zealand from January 1, 2009 and December 31, 2014. FBSA cases were compared with small-joint non-fight bite septic arthritis (SJNFBSA), and all NFBSA. P-values of ≤0.05 were considered significant.ResultsSixty-seven FBSA and 476 NFBSA cases (including 183 SJNFBSA) were identified. Compared with SJNFBSA and all NFBSA, FBSA was associated with younger age (median 26 years vs. 49 and 52, respectively) and tobacco use, but lower rates of diabetes, osteoarthritis and renal failure. Osteomyelitis was more common and metastatic infection less common in FBSA (all P ≤ 0.05). FBSA was more likely to be polymicrobial (76% vs. 30% and 20%), and to be caused by oral flora, oral streptococci, HACEK organisms, and anaerobes. SJNFBSA was less likely to be caused by S. aureus than FBSA. FBSA was more commonly managed operatively than SJNFBSA and all NFBSA (93% vs. 79% and 81%) and received shorter antibiotic courses (median 2 weeks vs. 4 and 5 weeks), more commonly orally (84% oral vs. 6% and 32%). Hospital length of stay for FBSA was shorter (median 4.5 days vs. 6 and 9 days). Compared with all NFBSA, treatment failure was less common (7% vs. 19%, P = 0.0242) and there was a trend toward lower mortality (0% vs. 5%, P = 0.0604).ConclusionFBSA represents a distinct subset of septic arthritis with differing morbidity and better outcomes than NFBSA. FBSA may be able to be safely managed with shorter, oral antibiotic regimens if adequate operative management is undertaken. Further studies are required to validate these findings.Disclosures All authors: No reported disclosures.

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Background: The New Zealand Rotator Cuff Registry represents the largest prospective cohort of rotator cuff repairs. Despite this, there are limited medium- to long-term data of rotator cuff repair outcomes. Purpose: To (1) analyze the pain and functional outcomes of a large cohort of primary rotator cuff repairs and (2) evaluate the effect of patient factors and tear characteristics on medium-term outcomes. Study Design: Cohort study; Level of evidence, 2. Methods: This was a multicenter, multisurgeon prospective cohort study of rotator cuff repairs from March 2009 until December 2010. Surgical data were collected by the operating surgeon. Primary outcome measures were the Flexilevel Scale of Shoulder Function (FLEX-SF) and a pain score, collected at baseline, 6, 12, and 24 months, and 5 years. Univariate and multivariate analyses were carried out. Results: Overall, 2533 primary rotator cuff repairs were analyzed with 81% follow-up at 5 years. The mean age of the cohort was 56 years. In the 2052 patients with final follow-up data, improvement on the FLEX-SF continued until 24 months postoperatively and remained high at 5 years. Mean improvement in FLEX-SF from baseline to 5 years was 15 points. Patients aged >70 years had lower FLEX-SF scores but no significant difference in improvement compared with patients ≤70 years. The mean anteroposterior tear size was 2.2 cm, and on multivariate analysis, tears >4 cm had worse 5-year FLEX-SF scores. If the affected tendon was easily reducible, there was no difference in FLEX-SF score for retracted or larger tears compared with smaller tears. The reoperation rate was 6.2%. Conclusion: Results indicated that rotator cuff repairs provide a sustained clinical improvement out past 5 years. Most functional improvement and pain relief occurred within the first 6 months, but improvement continued out to 24 months. Most population groups did well after rotator cuff repairs, including those >70 years. Tear size >4 cm and tendon reducibility correlated with outcome. Even patients with large tear sizes had clinically significant improvement in FLEX-SF scores after repair.