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

Abstract

Purpose Septic arthritis is a life-threatening emergency with high mortality of up to 11 %. We investigated if delay of arthroscopic lavage of infected major joints would have a bearing on the mortality and morbidity such as admission to an intensive care unit (ICU). Methods We retrospectively reviewed patients presenting with septic arthritis to two regional hospitals over a period of seven years from 1 January 2005 to 31 December 2011. We divided our sample of 82 patients into four groups based on the time delay between clinical diagnosis and arthroscopic lavage ranging from less than six hours to more than 24 hours. Results We determined that 35.4 % of patients had prosthetic joints. Knee joints were predominantly involved (74.4 %). Staphylococcus aureus was the most commonly isolated pathogen (41.5 %). There were ten (12.2 %) deaths and the same number of admissions to an ICU. Our study revealed there was no statistical significance between the time delay and mortality (P00.25) or ICU admission (P00.74) or the number of washouts (P00.08) in all four groups.Conclusions Up to 48 hours delayed arthroscopic lavage for septic arthritis does not increase the risk of mortality. Further prospective large sample studies are recommended to investigate this and the risk of long-term morbidity.

Native septic arthritis is not an immediate surgical emergency

“…the duration of patient symptoms prior to surgery, rather than the time they spent waiting in the emergency department. Many patients with septic arthritis may wait several days or weeks [10], with [25,26] or without antibiotic treatment, before being admitted for joint surgery. In our region, 42% of all infected patients were already receiving antibiotic therapy before they underwent emergency orthopedic surgery [27].…”

“…ang [34] 2003 58 Children University S. aureus 10 (17%) S. aureus none oss [28] 2003 77 Pneumococcal Literature review S. pneumoniae 20 (26%) not reported not reported inha [26] anmış [5] 2011 20 Adult knees University S. aureus 6 (30%) Gächter Score ≥ 3 none odomuri [10] 2012 82 Adults University S. aureus 19 (23%) Unknown none ee [33] 2015 31 Infant hips University S. aureus 5 (16%) Unidentified none akhni [36]…”

“…Acute native joint septic arthritis is typically considered a medical emergency, requiring urgent surgical intervention to help reduce cartilage damage and to preserve good long-term joint function [1][2][3][4][5][6][7][8][9][10]. Both surgeons and physicians are taught that they should ensure joint drainage is performed within hours after hospital admission, even in the absence of clinical evidence of sepsis or during night, weekend or holiday shifts.…”

“…We did not investigate the separate issue of mortality in cases of haemodynamically compromising sepsis [10,11].…”

Clinical and microbiological characteristics of patients with septic arthritis: A hospital-based study

“…1 This disease has a higher incidence with increased age, and many of the etiologies involved are associated with a significant disability or even death. 2 Cartilage destruction can occur within 1e2 days of the onset of symptoms 3 and is associated with a considerable mortality rate (up to 11%). 4 Joint infection may occur by hematogenous dissemination, spread from a contiguous infection, direct inoculation of the infectious agent or postoperative contamination.…”