Septic arthritis following arthroscopy: Clinical syndromes and analysis of risk factors

Armstrong, Robert W.; Bolding, Fern; Joseph, Ronald

doi:10.1016/0749-8063(92)90039-e

Cited by 221 publications

(167 citation statements)

References 22 publications

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“…There are other reported cases of septic arthritis in the literature with similarly low jWBC. [17][18][19][25][26][27][28][29][30] Although these data are consistent with some earlier studies, 17,18,25,29 they run contrary to the common notion that septic arthritis is infrequently seen in patients with jWBC less than 50,000 cells/mm 3 . Past studies have reported variable sensitivities of these ancillary tests for septic arthritis.…”

Section: Discussioncontrasting

confidence: 56%

“…The sensitivity of an elevated WBC ranges from 19% to 77%, 2,4-8,13-19,21,25-27,33 the sensitivity of an elevated ESR ranges from 71% to 94%, [2][3][4][5][6][7][8]14,15,[17][18][19][20][21]30,[33][34][35] and the sensitivity of a jWBC greater than 50,000 cells/mm 3 ranges from 0% to 92%. 1,3,[17][18][19]21,[25][26][27][28][29][30]33,36,37 Much of the literature consists of case series studies like ours, often with variable values for normal WBC, ESR, and jWBC. The studies also have heterogeneous control groups, making it difficult, if not impossible, to perform an adequate meta-analysis.…”

Section: Discussionmentioning

confidence: 99%

“…[16][17][18][19][20][21] In addition, although several emergency medicine textbooks indicate that a jWBC greater than 50,000 cells/mm 3 is likely to be ''positive,'' the number at which a jWBC is considered ''negative'' for septic arthritis varies from 2,000 to 10,000 cells/mm 3 in different texts. [22][23][24] There are several reports of septic arthritis in patients with low jWBCs, [17][18][19][25][26][27][28][29][30] so it is not clear if there is any jWBC that would rule out a septic joint. We conducted a retrospective case series study to determine the sensitivities of elevated WBC, ESR, and jWBC in adult patients with septic arthritis to determine whether a septic joint can be ruled out by any (or a combination of) these ancillary tests.…”

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confidence: 99%

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Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Henderson

Dickman

et al. 2004

Acad Emergency Med

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It is difficult to differentiate septic arthritis from other causes of monoarticular arthritis solely with a history and physical examination. The clinician must rely on ancillary tests to make a diagnosis, such as the white blood cell count of peripheral blood (WBC), the erythrocyte sedimentation rate (ESR), and the white blood cell count of the joint fluid ( jWBC) obtained from arthrocentesis. Although it is known that septic arthritis is associated with abnormalities in these tests, the majority of the data are based on studies in the pediatric population. In addition, although several emergency medicine texts indicate that a jWBC greater than 50,000 cells/mm 3 is ''positive,'' it is known that septic arthritis can occur in patients with low jWBCs. Objectives: To determine whether specific ancillary tests have sufficiently high sensitivities to rule out septic arthritis in adults.Methods: This was a retrospective consecutive case series of patients from an urban emergency department (ED). Patients at least 18 years old who had septic arthritis confirmed by positive arthrocentesis culture or operative findings were included in the study. WBC greater than 11,000 cells/mm 3 , ESR greater than 30 mm/hr, and jWBC greater than 50,000 cells/mm 3 were considered elevated. Results: Seventy-three patients met the inclusion criteria. The sensitivities of an elevated WBC, ESR, or jWBC in adults who had septic arthritis were 48%, 96%, and 64%, respectively. There were broad ranges of WBC, ESR, or jWBC among the patients. More than one third of adult patients with septic arthritis had jWBCs less than 50,000 cells/mm 3 . All patients had an abnormality in at least one of these tests. Conclusions: The WBC, ESR, and jWBC are extremely variable in adults with septic arthritis. Laboratory tests do not rule out septic arthritis with accuracy.

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Section: Discussioncontrasting

confidence: 56%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Henderson

Dickman

et al. 2004

Acad Emergency Med

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“…24 On the contrary, there are reports that the complications associated with intra-articular steroids are only rare. 25,26 We found no cases of post-operative infection at follow-up at one year.…”

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confidence: 66%

Multimodal periarticular cocktail injection using steroid in total knee arthroplasty: a double blind randomised trial

et al. 2017

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Background: Multimodal periarticular cocktail injection (MPCI) containing local anesthetics, adrenaline, and anti-inflammatory agents such as NSAIDS have been promising in terms of quick functional recovery. This study evaluates the efficiency of steroid as a component of MPCI in knee arthroplasty.Methods: This is a prospective, double-blind, RCT where 36 patients with osteoarthritis were included and randomized to receive MPCI either with steroid or without steroid. Pain was evaluated by visual analogue scale (VAS) at preoperative and postoperatively at rest, and during activity. The range of motion of the knee was looked for in a similar way. The amount of NSAIDs and the duration of NSAID usage were noted till the last follow-up.Results: Both non-steroid and steroid groups were similar with regard to VAS at rest and during activity, or range of motion, at all postoperative observations. The postoperative knee society knee score in the steroid group improved significantly as compared to that in non-steroid group at the one-month (84.1±13.1 and 65.9±12.1; p<0.0045) and three-month follow-up (90.2±16.3 and 72.5±16.6; p<0.0027), but no significant difference was noted at six-month follow up. There was no significant difference in consumption of NSAIDs within 72 hours between the two groups. The duration of piroxicam usage in patients in the steroid group was significantly shorter than that in the non-steroid group, (7.2±0.7) compared with (10.5±1.9) weeks; =0.012.Conclusions: The Study validates usage of steroid in MPCI due to faster rehabilitation and less consumption of NSAIDs and no additional risk of post-operative complications.

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“…Arthroscopically assisted biopsies faces the risk of infection or other perioperative complications. 7 In our opinion the risk of infection with the described method is minimal and comparable to that of knee punctures, provided that the procedure is performed following the rules of an aseptic joint puncture. The limitation of this biopsy technique is the lack of localization of a specific area of the synovial membrane to be biopsied.…”

Section: Discussionmentioning

confidence: 99%

Retrograde Synovial Biopsy of the Knee Joint Using a Novel Biopsy Forceps

Hügle

Leumann

Pagenstert

et al. 2014

Arthroscopy Techniques

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Synovial biopsies of the knee joint are commonly performed arthroscopically with the patient under full or regional anesthesia. To overcome the effort, costs, and potential risks of surgery, we developed an office-based technique for retrograde synovial biopsy using a designated novel biopsy forceps. Using this technique, no arthroscopic or radiologic control is needed to perform rapid synovial biopsies of the knee joint. Concomitant aspiration of synovial fluid can be performed. A technical description of the procedure is given.

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Septic arthritis following arthroscopy: Clinical syndromes and analysis of risk factors

Cited by 221 publications

References 22 publications

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Laboratory Tests in Adults with Monoarticular Arthritis: Can They Rule Out a Septic Joint?

Multimodal periarticular cocktail injection using steroid in total knee arthroplasty: a double blind randomised trial

Retrograde Synovial Biopsy of the Knee Joint Using a Novel Biopsy Forceps

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