Arthroscopic management of septic arthritis: stages of infection and results

Abstract

Seventy-six patients with septic arthritis (78 affected joints) were treated with a combination of arthroscopic irrigation, debridement, and antibiotic therapy according to the tested bacterial sensitivity. There were 62 knee, 10 shoulder, 5 ankle joints, and 1 hip joint. No antibiotics were added to the irrigating solution. The arthroscopic and radiological stage of infection, treatment, and outcome in these patients was analyzed. The patients were classified into three groups according to initial stage of joint infection (stage I: 21 patients, 22 joints; stage II: 43 patients, 44 joints; stage III: 12 patients, 12 joints). Causes of infection were: hematogenous dissemination in 54%, postoperative wound infection in 28% (17% after open, 11% after arthroscopic procedures). Other causes were: 10% intra-articular steroid injections, 3% diagnostic punctures, and 3% open traumatic injury of the joint. In 78% of the infected joints the causative organism could be identified: Staphylococcus aureus was the most common organism found (42%), followed by streptococci (15%), pneumococci (6%), Escherichia coli (4%), Staphylococcus epidermidis (3%), Borrelia burgdorferi (3%), and others in 5%. In the stage I group only one patient needed repeated arthroscopic irrigation, in the stage II group 52%, and in the stage III group 75%. Open revision for eradication of the infection was necessary in one joint with stage II and in two joints with stage III infection (3%). Two joints of the stage III group needed additional surgery after successful treatment of the infection. The combination of arthroscopic irrigation and systemic antibiotic therapy was able to cure 91% of the affected joints. Open revision was necessary in 4% of joints. The number of arthroscopic procedures and the efficacy of treatment depended on the initial stage of the infection. It is concluded that an arthroscopic staging of the initial joint infection has prognostic and therapeutic consequences.

Time delay between diagnosis and arthroscopic lavage in septic arthritis. Does it matter?

“…Arthroscopy has been shown to be an effective surgical treatment measure for joint infections with successful outcomes from 91 to 98 % of treated patients [13,18]. We consider our procedure successful in 98 % of this patient group; 43.9 % of our sample needed more than one arthroscopic lavage.…”

“…A prospective observational study would be marginally stronger than our retrospective cohort study; however, it would be deemed unethical to randomise patients into such a setting. This would explain why almost all the studies in this field have been observational [13,16,17,19]. Our hospitals did not follow the Gächter classification in assessing the grade of infection [13].…”

“…This would explain why almost all the studies in this field have been observational [13,16,17,19]. Our hospitals did not follow the Gächter classification in assessing the grade of infection [13]. Thus we could not analyse the extent of chondrocyte damage of the native joints.…”

“…A systematic review performed by Mathews et al found that no investigation is more reliable than clinical diagnosis of an experienced doctor [11]. Arthroscopic lavage has been shown to be effective in the surgical management of infectious arthritis [12,13]. However, there is hardly any evidence suggesting a time frame for the surgical management of acute septic arthritis.…”

Use of a latissimus dorsi flap for treatment of infection in a neuropathic shoulder joint

“…The treatment options available for septic shoulder are aspiration and instillation of antibiotics into the joint plus systemic administration of antibiotics, arthroscopic treatment, operative debridement, and arthrodesis. 6,[11][12][13] There are no published comparative studies on the various approaches to treatment. Nord et al 14 were not able to detect any significant differences in outcome following various therapeutic and surgical approaches.…”