Septic Arthritis of the Shoulder: A Comparison of Treatment Methods

Jiang, Jiaren; Piponov, Hristo; Mass, Daniel P.; Angeles, Jovito; Shi, Lewis L.

doi:10.5435/jaaos-d-16-00103

Cited by 38 publications

(19 citation statements)

References 14 publications

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“…[16][17][18][19] The percentage of patients afflicted by septicemia and septic shock were also reported in Jiang et al's study at 24.2% and 2.3%, respectively. 16 Hematogenous spread from bacteremia is the most common cause of septic arthritis representing roughly 70% of cases, and bacteremia is more likely to affect a large joint with pre-existing arthritis. 2 Therefore, the patient's underlying osteoarthritis put him at higher risk for hematogenous seeding of this joint.…”

Section: Discussionsupporting

confidence: 67%

“…Septic arthritis of the shoulder accounts for 5%-12% of all cases of septic arthritis with the overall incidence being 3200 cases per year in the USA. [14][15][16] Jiang et al reviewed 7145 cases of native shoulder septic arthritis in the USA, finding that the overall inpatient mortality rate was 2.6% for these patients, while other studies have reported mortality rates as high as 11%-17%. [16][17][18][19] The percentage of patients afflicted by septicemia and septic shock were also reported in Jiang et al's study at 24.2% and 2.3%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…[14][15][16] Jiang et al reviewed 7145 cases of native shoulder septic arthritis in the USA, finding that the overall inpatient mortality rate was 2.6% for these patients, while other studies have reported mortality rates as high as 11%-17%. [16][17][18][19] The percentage of patients afflicted by septicemia and septic shock were also reported in Jiang et al's study at 24.2% and 2.3%, respectively. 16 Hematogenous spread from bacteremia is the most common cause of septic arthritis representing roughly 70% of cases, and bacteremia is more likely to affect a large joint with pre-existing arthritis.…”

Section: Discussionmentioning

confidence: 99%

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Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

2021

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Prompt recognition and treatment of septic arthritis are crucial to prevent significant morbidity and mortality in affected patients. During the current COVID-19 pandemic, anchoring bias may make an already challenging diagnosis like septic arthritis more difficult to diagnose quickly and efficiently. Musculoskeletal (MSK) point of care ultrasonography (POCUS) is an imaging modality that can be used to quickly and efficiently obtain objective findings that may help a clinician establish the diagnosis of septic arthritis. We report a case where MSK POCUS was a key element in establishing the diagnosis of glenohumeral joint septic arthritis and subdeltoid septic bursitis for a patient that presented to the emergency department with a fever during the era of the COVID-19 pandemic.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

2021

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“…It is possible that shoulder SA may be under‐evaluated and under‐diagnosed. The most common cause of septicemia as a complication of shoulder SA has been attributed to MSSA 20,22 . To our knowledge, our study is the first to find MRSA as the most common pathogen causing shoulder SA.…”

Section: Discussionmentioning

confidence: 55%

The profile of the causative organisms which lead to septic arthritis of native joints over the last two decades in a single tertiary medical center in the east coast of the United States

Arieli

Fowler

Lieber

et al. 2021

Int J Clinical Practice

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Background: Septic arthritis (SA) is associated with significant morbidity and mortality. Delayed or inadequate treatment may result in joint destruction, osteomyelitis and sepsis. Like other types of infection, the causative agents of SA may have changed over time. Early targeted intervention is important in cases of SA and can be achieved only by understanding the current trends in the microbiology of SA.Objectives: To determine the trends in the microbiology of SA over the last two decades. Methods:We conducted a retrospective study including all patients 18 and older with culture positive, surgically treated, native joint septic arthritis (NJSA), admitted to a single tertiary medical centre in Boston between the years of 1997 and 2015.We excluded cases of osteomyelitis and septic bursitis. We focused our analysis on the microbiology data which included synovial fluid gram stain and culture, blood cultures and synovial biopsy cultures. How to cite this article: Arieli MM, Fowler ML, Lieber SB, Shmerling RH, Paz Z. The profile of the causative organisms which lead to septic arthritis of native joints over the last two decades in a single tertiary medical center in the east coast of the United States.

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“…However, Bovonratwet et al [ 18 ] reported similar rates of reoperation and postoperative complications between the two surgical methods. Jiang et al [ 19 ] also reported no difference in the reoperation rate between these two surgical methods. Some studies showed that arthroscopic surgery is ineffective on higher Gächter stages of septic arthritis [ 9 , 20 ].…”

Section: Discussionmentioning

confidence: 99%

Arthroscopic Treatment of Septic Arthritis of the Shoulder: Technical Pearls to Reduce the Rate of Reoperation

Kwon

Park

Park³

et al. 2020

Clin Shoulder Elbow

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Background: The aim of this study was to evaluate clinical experience with arthroscopic debridement for septic arthritis of the shoulder joint and to report on our patient outcomes.Methods: The retrospective analysis included 36 shoulders (male:female, 15:21), contributed by 35 patients (mean age, 63.8 years) treated by arthroscopy for septic arthritis of the shoulder between November 2003 and February 2016. The mean follow-up period was 14.3 months (range, 12–33 months). An additional posterolateral portal and a 70º arthroscope was used to access the posteroinferior glenohumeral (GH) joint and posteroinferior subacromial (SA) space, respectively. Irrigation was performed with a large volume of fluid (25.1±8.1 L). Multiple suction drains (average, 3.3 drains) were inserted into the GH joint and SA space and removed 8.9±4.3 days after surgery. Intravenous antibiotics were administered for 3.9±1.8 weeks after surgery, followed by oral antibiotic treatment for another 3.6±1.9 weeks.Results: Among the 36 shoulders, reoperation was required in two cases (5.6%). The average range of motion achieved was 150.0º for forward flexion and T9 for internal rotation. The mean simple shoulder test score was 7.9±3.6 points. Nineteen shoulders (52.8%) had acupuncture or injection history prior to the infection. Pathogens were identified in 15 shoulders, with Staphylococcus aureus being the most commonly identified pathogen (10/15). Both the GH joint and the SA space were involved in 21 shoulders, while 14 cases involved only the GH joint and one case involved only the SA space. Conclusions: Complete debridement using an additional posterolateral portal and 70º arthroscope, a large volume of irrigation with >20 L of saline, and multiple suction drains may reduce the reoperation rate.

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Septic Arthritis of the Shoulder: A Comparison of Treatment Methods

Abstract: Therapeutic level III.

Cited by 38 publications

References 14 publications

Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

Utilisation of musculoskeletal ultrasonography for the evaluation of septic arthritis in a patient presenting to the emergency department with fever during the era of COVID-19

The profile of the causative organisms which lead to septic arthritis of native joints over the last two decades in a single tertiary medical center in the east coast of the United States

Arthroscopic Treatment of Septic Arthritis of the Shoulder: Technical Pearls to Reduce the Rate of Reoperation

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