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McKenna DP, Miller P, McAleese T, Cleary M. Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review. J Exp Orthop 2024; 11:e12041. [PMID: 38846377 PMCID: PMC11154831 DOI: 10.1002/jeo2.12041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/19/2024] [Accepted: 04/23/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose Septic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary objective of any treatment is complete source control. This commonly takes the form of antibiotic therapy and a washout of the infected joint by means of arthroscopy or arthrotomy. The primary aim of this review is to investigate if arthroscopic washout for native knee septic arthritis confers a lower risk of repeat procedure than arthrotomy. Methods A systematic review and meta-analysis was conducted of the MEDLINE, SCOPUS and the Cochrane Library data bases. The primary outcome of interest was requirement for repeat washout with all-cause complications, length of inpatient stay and mortality secondary outcomes. Results A total of 17,140 subjects were included for analysis of the primary outcome, and the overall rate of repeat procedure was 14.6%. No statistical difference was found between arthroscopy and arthrotomy for repeat washout (risk ratio 0.86 [95% confidence interval, CI: 0.72-1.02], I 2 = 36%). Eligible studies found in favour of arthroscopy for all-cause complication rate (risk ratio 0.75 [95% CI: 0.6-0.93], I 2 = 84%) and length of stay in hospital (mean difference -1.98 days [95% CI: -3.43 to -0.53], I 2 = 84%). No statistical difference was found for the mortality rate (risk ratio 1.17 [95% CI: 0.52-2.63], I 2 = 57%). Conclusion Our analysis found arthroscopy and open arthrotomy to be equivocal for repeat surgical washout in native knee septic arthritis. All-cause complication rate and length of inpatient stay were favourable for arthroscopy with no difference noted between mortality rates. Level of Evidence Level III.
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Affiliation(s)
- Daniel P. McKenna
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
| | - Peggy Miller
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
| | - Timothy McAleese
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
| | - May Cleary
- Department of Trauma and Orthopaedic SurgeryUniversity Hospital WaterfordWaterfordIreland
- Department of Orthopaedic SurgeryUniversity College CorkCorkIreland
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Hodea FV, Grosu-Bularda A, Teodoreanu RN, Cretu A, Ratoiu VA, Lascar I, Hariga CS. Early Intervention in Septic Arthritis of the Hand, Optimizing Patient Outcomes in Hand Infections-A Five-Year Retrospective Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:895. [PMID: 38929511 PMCID: PMC11205443 DOI: 10.3390/medicina60060895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 05/20/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024]
Abstract
Background and Objectives: Hand septic arthritis is a potentially debilitating condition that can significantly affect patient functionality and quality of life. Understanding the demographic, clinical, and microbiological characteristics of this condition is crucial for its effective treatment and management. This study aimed to analyze the demographic and clinical profiles of patients with hand septic arthritis, to identify common microbial pathogens, and to evaluate the impact of various factors on clinical course and treatment outcomes. Material and Methods: This cross-sectional retrospective study examined patients diagnosed with septic arthritis of the hand, focusing on their demographic data, clinical presentation, causative organisms, treatment methods, and outcomes. Data on age, sex, cause of infection, affected sites, surgical interventions, microbiological findings, and patient outcomes were also collected. Results: This study found a higher prevalence of septic arthritis in males and identified bite as the predominant cause. Staphylococcus aureus is the most common pathogen. A large number of patients did not exhibit bacterial growth, and bacterial resistance did not significantly affect the outcome. Outcomes were statistically influenced by the timing of medical presentation and the presence of comorbidities. Conclusions: Early diagnosis and intervention are critical for effective management of hand septic arthritis. This study underscores the need for a comprehensive approach that considers patient demographic and clinical characteristics to optimize treatment outcomes. Awareness and preventive measures are essential to reduce the incidence and severity of this condition.
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Affiliation(s)
- Florin-Vlad Hodea
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Andreea Grosu-Bularda
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Razvan Nicolae Teodoreanu
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Andrei Cretu
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Vladut-Alin Ratoiu
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Ioan Lascar
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
| | - Cristian-Sorin Hariga
- Department 11, Discipline Plastic and Reconstructive Surgery, Bucharest Clinical Emergency Hospital, University of Medicine and Pharmacy Carol Davila, 050474 Bucharest, Romania; (F.-V.H.); (R.N.T.); (I.L.); (C.-S.H.)
- Clinic of Plastic Surgery, Aesthetic and Reconstructive Microsurgery, Emergency Clinical Hospital Bucharest, 050474 Bucharest, Romania; (A.C.); (V.-A.R.)
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Pesante BD, Salimi M, Miller WL, Young HL, Jenkins TC, Parry JA. Associations with unplanned repeat irrigation and debridement of native septic arthritis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:2179-2184. [PMID: 38573381 DOI: 10.1007/s00590-024-03912-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/14/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To identify associations with unplanned repeat irrigation and debridement (I&D) after arthrotomy for native septic arthritis. METHODS A retrospective review identified patients with native septic arthritis treated with open arthrotomies. The primary outcome was unplanned repeat I&D within 90 days. Associations evaluated for included comorbidities, ability to bear weight, fever, immunosuppressed status, purulence, C-reactive protein, erythrocyte sedimentation rate, white blood cell count (synovial fluid and serum levels), and synovial fluid polymorphonuclear cell percentage (PMN%). RESULTS There were 59 arthrotomies in 53 patients involving the knee (n = 32), shoulder (n = 10), elbow (n = 8), ankle (n = 6), and hip (n = 3). The median patient age was 52, and a 71.2% were male. An unplanned repeat I&D was required in 40.7% (n = 24). The median time to the second I&D was 4 days (interquartile range 3 to 9). On univariate analysis, unplanned repeat I&Ds were associated with fever (p = 0.03), purulence (p = 0.01), bacteria growth on cultures (p = 0.02), and the use of deep drains (p = 0.05). On multivariate analysis, the only variables that remained associated with unplanned repeat I&Ds were fever (odds ratio (OR) 5.5, 95% confidence interval (CI) 1.3, 23.6, p = 0.02) and purulence (OR 5.3, CI 1.1, 24.4, p = 0.03). CONCLUSIONS An unplanned repeat I&D was required in 40.7% of patients and was associated with fever and purulence. These findings highlight the difficulty of controlling these infections and support the need for future research into better methods of management. LEVEL OF EVIDENCE Diagnostic, Level III.
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Affiliation(s)
- Benjamin D Pesante
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
| | - Maryam Salimi
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA
| | - Whitney L Miller
- Department of Medicine - Infectious Disease, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Heather L Young
- Department of Medicine - Infectious Disease, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Timothy C Jenkins
- Department of Medicine - Infectious Disease, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO, USA
| | - Joshua A Parry
- Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver Health, 777 Bannock St, MC 0188, Denver, CO, 80204, USA.
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Puzzitiello RN, Agarwalla A, Masood R, Bragg J, Hanna J, Pagani NR, Salzler MJ. Arthroscopic Treatment Is a Safe and Effective Alternative to Open Treatment for Acute Septic Arthritis of the Native Knee: A Systematic Review. Arthroscopy 2024; 40:972-980. [PMID: 37437787 DOI: 10.1016/j.arthro.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/10/2023] [Accepted: 05/30/2023] [Indexed: 07/14/2023]
Abstract
PURPOSE To compare complication rates, reoperation rates, and subjective outcomes after arthroscopic and open irrigation and debridement for treatment of native knee septic arthritis. METHODS Following The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, a systematic review of the Embase, Cochrane, and PubMed databases was performed. Comparative studies reporting clinical outcomes after arthroscopic versus open treatment for septic arthritis of the native knee in human adults were included. Excluded were case series with <10 patients, inclusion of patients <18 years old, studies on non-native joints, abstract-only publications, and studies without stratification of the involved joint. Two reviewers in duplicate independently performed search and data extraction. The quality of the included studies was assessed with the Methodological Index for Non-Randomized Studies instrument. The mean score among the included studies was 18.2 (range 16-23). RESULTS Eleven studies were included, comprising 2,343 knees treated arthroscopically, and 1,595 treated with arthrotomy. Studies reported no differences in erythrocyte sedimentation rate, C-reactive protein, peripheral white blood cells, or symptom chronicity between groups. Nine studies (81.8%) attempted to control for potentially confounding variables in their analyses, and 4 studies (36.4%) reported significant differences in patient characteristics. Reoperation rates ranged from 0% to 50% for arthroscopy and 6% to 71% for arthrotomy. Complication rates ranged from 0% to 39.4% arthroscopically and 0% to 49% for arthrotomy. Superior patient-reported outcomes were achieved after arthroscopy in 2 studies that analyzed subjective outcomes. CONCLUSIONS Arthroscopic management of native knee septic arthritis is a safe and effective alternative to open treatment and is associated with comparable complication rates, reoperation rates, hospitalization lengths, readmission rates, and superior patient-reported outcomes compared with open irrigation and debridement. LEVEL OF EVIDENCE Level IV, systematic review of Level I, III, and IV studies.
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Affiliation(s)
| | - Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, New York, U.S.A
| | - Raisa Masood
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Jack Bragg
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - John Hanna
- Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island, U.S.A
| | - Nicholas R Pagani
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Matthew J Salzler
- Department of Orthopaedics, Tufts Medical Center, Boston, Massachusetts, U.S.A..
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5
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Burdick GB, Maier LM, Kuhlmann NA, Ayoola AS, Fathima B, Muh SJ. Clinical characteristics and long-term outcomes of septic arthritis of the native hip joint: a 20-year retrospective review. Hip Int 2024; 34:194-200. [PMID: 37728010 DOI: 10.1177/11207000231200175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/21/2023]
Abstract
BACKGROUND The primary purpose of this retrospective case series was to describe the prevalence and outcomes of single-stage hip arthroplasty in patients who were previously treated for septic arthritis of the native hip at our institution over a 20-year period. This study also examined rates of persistent or recurrent infection, reoperation, and mortality for septic arthritis of the native hip. METHODS Adult patients treated for septic arthritis of the native hip at our institution from 1995 to 2015 were retrospectively identified. Exclusion criteria included age <18 years, missing or incomplete medical records, treatment at an outside institution, and prior surgery of the hip. RESULTS 97 patients were included in this study. 3 patients (3.1%) who were previously treated for septic arthritis of the native hip underwent single-stage hip arthroplasty an average of 40 ± 25 months from the date of infection. 3 of the 18 (16.7%) patients who were treated with resection arthroplasty underwent second-stage joint reconstruction. There were no cases of periprosthetic joint infection (PJI). 1 patient who underwent single-stage arthroplasty experienced implant-induced metallosis, necessitating removal of the implant. There were no other cases of revision arthroplasty. CONCLUSIONS The prevalence of single-stage hip arthroplasty in patients with a history of septic arthritis of the native hip joint was 3.1%, which is higher than the prevalence of hip arthroplasty in the United States general population, suggesting that a history of septic arthritis may increase the risk of requiring hip arthroplasty. In the small number of patients who went on to receive a hip replacement, there were no reported cases of PJI. This study suggests that hip arthroplasty is a viable option for patients with symptomatic osteoarthritis and a history of septic arthritis of their hip.
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Affiliation(s)
- Gabriel B Burdick
- Department of Orthopaedic Surgery, University of Southern California, Los Angeles, CA, USA
| | - Lindsay M Maier
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Noah A Kuhlmann
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Ayooluwa S Ayoola
- Department of Orthopaedic Surgery, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI, USA
| | - Bushra Fathima
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
| | - Stephanie J Muh
- Department of Orthopaedic Surgery, Henry Ford Health, Detroit, MI, USA
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Chen CY, Lin CP, Tsai CH, Chen HY, Chen HT, Lin TL. Medullary-Sparing Antibiotic Cement Articulating Spacer Reduces the Rate of Mechanical Complications in Advanced Septic Hip Arthritis: A Retrospective Cohort Study. J Pers Med 2024; 14:162. [PMID: 38392594 PMCID: PMC10890418 DOI: 10.3390/jpm14020162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 01/06/2024] [Accepted: 01/29/2024] [Indexed: 02/24/2024] Open
Abstract
Antibiotic cement articulating spacers eradicate infection during a two-stage revision for advanced septic hip arthritis (ASHA); however, mechanical complications have been reported. We hypothesized that the rate of mechanical complications would be lower in medullary-sparing (MS) than in non-medullary-sparing (n-MS) articulating spacers. A retrospective study of ASHA using n-MS or MS spacers was conducted between 1999 and 2019. The rate of mechanical complications and reoperation and risk factors for mechanical complications were analyzed. The cohort included 71 n-MS and 36 MS spacers. All patients were followed up for 2 years. The rate of spacer dislocation was lower in MS (0%) than in n-MS spacers (14.1%; p = 0.014). The reoperation rate for mechanical complications was lower in MS (0%) than in n-MS spacers (12.7%; p = 0.019). The rate of a diaphyseal stem during reimplantation was lower in MS (0%) than in n-MS spacers (19.4%; p = 0.002). The identified risk factors for n-MS spacer dislocation were postoperative under-restored femoral head diameter ≥3 mm, femoral offset ≥3 mm, and surgical volume (≤6 resection arthroplasties per year). Both spacers controlled infection. However, MS spacers had a lower spacer dislocation and reoperation rate and avoided the diaphyseal stem during reimplantation. We recommend using MS spacers to restore native femoral head diameter and femoral offset when ASHA is treated by surgeons with lower surgical volumes.
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Affiliation(s)
- Chun-Yen Chen
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
| | - Chin-Ping Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
| | - Chun-Hao Tsai
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
| | - Hui-Yi Chen
- Department of Radiology, China Medical University Hospital, Taichung 40447, Taiwan
| | - Hsien-Te Chen
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
| | - Tsung-Li Lin
- Department of Orthopedics, China Medical University Hospital, Taichung 40447, Taiwan
- Department of Sports Medicine, College of Health Care, China Medical University, Taichung 406040, Taiwan
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 40402, Taiwan
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Garg V, Singh V, Kalia RB, Regmi A, Yasam R, Sinha SK. Role of Magnetic Resonance Imaging in Concomitant Periarticular Infections in Septic Arthritis of Large Joints in Children: A Systematic Review. JOURNAL OF THE WEST AFRICAN COLLEGE OF SURGEONS 2024; 14:83-89. [PMID: 38486643 PMCID: PMC10936883 DOI: 10.4103/jwas.jwas_83_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/12/2023] [Indexed: 03/17/2024]
Abstract
Background Septic arthritis associated with adjacent infections, presents a diagnostic challenge as the clinical presentation is similar to that of isolated septic arthritis, additional diagnostic tools are needed to detect these infections. The purpose of this study was to examine the effectiveness of magnetic resonance imaging (MRI) for diagnosis of concomitant infection in children with septic arthritis of large joints and its effect on patient outcome and treatment. Materials and Methods Electronic literature research of PubMed, Cochrane and Scopus, was conducted in January 2022 using a combination of MeSH, search terms and keywords. The data extracted included the study details, demographic data, the proportion of patients having a concomitant periarticular infection, clinical presentation, blood parameters and culture findings and outcomes. Results This review included seven studies with 499 patients. The mean age was 7.08 ± 2.38 years in the study. There was a male predominance, with 174 being males (62.36%). The most common joint involved was the hip joint (44.47%). 42.48% had concomitant periarticular infections detected by MRI. Osteomyelitis was the most common infection seen in 209 patients (41.84%). The mean duration of antibiotics given and hospital stay was significantly more in periarticular infections (P > 0.05). 32.5% of the patients with septic arthritis underwent a second surgical procedure whereas 61.11% of patients with periarticular infections underwent second procedure in this review (P > 0.05). Conclusions The use of MRI to diagnose these complicated infections appears to be beneficial. Multi-centric randomised control trials are needed to investigate the efficacy of MRI and its impact on patient care and outcome.
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Affiliation(s)
- Varun Garg
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Vivek Singh
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Roop Bhusan Kalia
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Anil Regmi
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Ramapriya Yasam
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
| | - Sourabh Kumar Sinha
- Department of Orthopedics, All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India
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Rodrigues TC, Taneja AK, Skaf A, Godoy IRB. Upper extremity infection: imaging features with focus on magnetic resonance imaging. Skeletal Radiol 2023:10.1007/s00256-023-04545-8. [PMID: 38097765 DOI: 10.1007/s00256-023-04545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/01/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. KEY FINDINGS: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions.
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Affiliation(s)
- Tatiane Cantarelli Rodrigues
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Abdalla Skaf
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Ivan Rodrigues Barros Godoy
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil.
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil.
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil.
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Nasim O, Khalil A, Khan S, Kohli S, Pantelias C, Banoori F, Durrani A, Karim A, Moverley R. Microbiological Profile and Clinical Features of Septic Arthritis of the Shoulder: A 10-Year Cohort Single-Centre Study. Cureus 2023; 15:e51074. [PMID: 38269230 PMCID: PMC10807700 DOI: 10.7759/cureus.51074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Septic arthritis (SA) constitutes a pressing orthopedic emergency characterized by acute, non-traumatic joint pain. Timely diagnosis and intervention are imperative to avert complications such as chondrolysis and systemic sepsis. The etiology is predominantly hematogenous, necessitating an integrated approach involving surgical and microbiological modalities. Shoulder aspiration and microbiological analysis play pivotal roles in guiding treatment, especially when positive findings prompt more aggressive therapeutic strategies. This study aims to elucidate the nuanced clinical and epidemiological characteristics of septic arthritis in both native and prosthetic joints within a singular institutional cohort over a decade. Methods This retrospective case series analysis spanned a 10-year period, focusing on non-prosthetic shoulder joints from January 2012 to July 2021. In this timeframe, only 183 aspirations were performed and sent to the microbiology department for analysis, including cultures, microscopy, and antibiotic sensitivity tests for positive cultures. The study delved into the microbiological profile of infections, encompassing gram stain, culture positivity rates, identification of microorganisms, and antibiotic susceptibility patterns. Additionally, the incidence of primary joint infections with resistant strains, particularly methicillin-resistant Staphylococcus aureus (MRSA), was scrutinized. Statistical analysis utilized the SPSS program version 20.0 (IBM Inc., Armonk, New York), with a significance level set at 5%. The project, registered with the trust's clinical audit department (Reg #5372), adhered to the Declaration of Helsinki and good clinical practice guidelines. Data collection involved extracting non-identifiable patient modifiers from the laboratory database bank into Excel spreadsheets. Results The study included 183 patients, with 108 (59%) females and 75 (41%) males. The average age was 76.2±16.5 years. Among them, 138 (75.4%) reported pain, and 15 (8.2%) had a body temperature over 37.8°C. Lab results showed a mean white blood cell count of 11.6±4.5 and an average C-reactive protein level of 121.7±102.1. Leucocytosis (>11,000 WBC) was seen in 82 (44.8%) cases. Elevated C-reactive protein (CRP; >10 mg/dl) was found in 136 (74.3%) patients. Synovial fluid analysis revealed no crystals in 91.3% of cases. Microbial resistance analysis showed 19 strains resistant to co-trimoxazole and 11 to erythromycin. Among co-trimoxazole-resistant strains, 73.7% were Staphylococcus aureus, a statistically significant association (p<0.001). Conclusion The evolving sensitivity patterns of microbes in septic arthritis underscore the necessity to reassess empirical antibiotic therapy. Subsequent joint damage resulting from infection can result in substantial disability.
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Affiliation(s)
- Omer Nasim
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Aamir Khalil
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Salman Khan
- Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Suraj Kohli
- Trauma and Orthopedics, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Charalampos Pantelias
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Fatima Banoori
- General Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Abdullah Durrani
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Arsallan Karim
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Robert Moverley
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
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10
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Bois AJ, Gabig AM, Griffin LP, Rockwood CA, Brady CI, Dutta AK. The evaluation, classification, and management of septic arthritis of the shoulder: the comprehensive shoulder sepsis system. J Shoulder Elbow Surg 2023; 32:2453-2466. [PMID: 37331502 DOI: 10.1016/j.jse.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Septic arthritis of the shoulder is distinctly challenging to diagnose and treat. Guidelines for appropriate workup and management are limited and do not account for the variations in clinical presentation. The purpose of this study was to present a comprehensive and anatomically based classification system and treatment algorithm for septic arthritis of the native shoulder joint. METHODS A multicenter, retrospective analysis of all patients treated surgically for septic arthritis of the native shoulder joint was performed at 2 tertiary care academic institutions. Preoperative magnetic resonance imaging and operative reports were used to classify patients as having 1 of 3 infection subtypes: type I, confined to the glenohumeral joint; type II, extra-articular extension; or type III, concomitant osteomyelitis. On the basis of these clinical groupings of patients, the comorbidities, types of surgical management, and outcomes were analyzed. RESULTS Sixty-five shoulders in 64 patients met the inclusion criteria for the study. Of these infected shoulders, 9.2% had type I infections, 47.7% had type II, and 43.1% had type III. Age and the time between symptom onset and diagnosis were the only significant risk factors for the development of a more severe infection. Fifty-seven percent of shoulder aspirates revealed cell counts below the standard surgical cutoff of 50,000 cells/mL. On average, each patient required 2.2 surgical débridements to eradicate the infection. Infections recurred in 8 shoulders (12.3%). Body mass index was the only risk factor for recurrence of infection. Of the 64 patients, 1 (1.6%) died acutely of sepsis and multiorgan system failure. CONCLUSION We propose a comprehensive system for the classification and management of spontaneous shoulder sepsis based on stage and anatomy. Preoperative magnetic resonance imaging can help determine the severity of disease and aid in surgical decision making. A systematic approach to septic arthritis of the shoulder as a unique entity from septic arthritis of other large peripheral joints may lead to more timely diagnosis and treatment and improve the overall prognosis.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Andrew M Gabig
- Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Charles A Rockwood
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Christina I Brady
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anil K Dutta
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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11
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Kim J, Park SY, Sohn KM, Kim B, Joo EJ. Methicillin Resistance Increased the Risk of Treatment Failure in Native Joint Septic Arthritis Caused by Staphylococcus aureus. Antibiotics (Basel) 2023; 12:1628. [PMID: 37998830 PMCID: PMC10669189 DOI: 10.3390/antibiotics12111628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/09/2023] [Accepted: 11/12/2023] [Indexed: 11/25/2023] Open
Abstract
This study aimed to compare clinical characteristics and outcomes in patients with native joint septic arthritis (NJSA) due to methicillin-resistant Staphylococcus aureus (MRSA) in comparison to methicillin-sensitive S. aureus (MSSA) and identify treatment failure risk factors. We conducted a multi-center retrospective study on adult NJSA patients at three teaching hospitals in South Korea from 2005 to 2017. Among 101 patients diagnosed with S. aureus NJSA, 39 (38.6%) had MRSA strains. Compared to MSSA, patients with MRSA had a higher prevalence of nosocomial infections (17.9% vs. 1.6%; p = 0.005) and received inappropriate antibiotics within 48 h more frequently (74.4% vs. 0%; p < 0.001). In total, twenty patients (19.8%) experienced treatment failure, which encompassed five patients (5.0%) who passed away, nine (8.9%) requiring repeated surgical drainage after 30 days of antibiotic therapy, and seven (6.9%) with relapse. The MRSA group showed a higher rate of overall treatment failure (33.3% vs. 11.3%; p = 0.007) with a notably increased frequency of requiring repeated surgical interventions after 30 days of antibiotic therapy (17.9% vs. 3.2%, p = 0.026), in contrast to the MSSA group. Independent risk factors for treatment failure included Charlson comorbidity score, elevated CRP levels, and methicillin resistance. Methicillin resistance is an independent risk factor for treatment failure, emphasizing the need for vigilant monitoring and targeted interventions in MRSA-related NJSA cases.
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Affiliation(s)
- Jungok Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong 30099, Republic of Korea;
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Deajeon 35015, Republic of Korea;
| | - So Yeon Park
- Division of Infectious Diseases, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Seoul 05355, Republic of Korea;
| | - Kyung Mok Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Deajeon 35015, Republic of Korea;
| | - Bomi Kim
- Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Seoul 03181, Republic of Korea
| | - Eun-Jeong Joo
- Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Seoul 03181, Republic of Korea
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12
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Walinga AB, Stornebrink T, Emanuel KS, Kievit AJ, Janssen SJ, Kerkhoffs GMMJ. Failure rates in surgical treatment in adults with bacterial arthritis of a native joint: a systematic review of 8,586 native joints. Arch Orthop Trauma Surg 2023; 143:6547-6559. [PMID: 37395855 PMCID: PMC10541340 DOI: 10.1007/s00402-023-04958-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 06/22/2023] [Indexed: 07/04/2023]
Abstract
INTRODUCTION Most adult cases of bacterial-septic-arthritis of a native joint are effectively managed with a single surgical debridement, but some cases may require more than one debridement to control the infection. Consequently, this study assessed the failure rate of a single surgical debridement in adults with bacterial arthritis of a native joint. Additionally, risk factors for failure were assessed. MATERIALS AND METHODS The review protocol was registered on PROSPERO (CRD42021243460) before data collection and conducted in line with the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' (PRISMA) guidelines. Multiple libraries were systematically searched to identify articles including patients reporting on the incidence of failure (i.e. persistence of infection requiring reoperation) of the treatment of bacterial arthritis. The quality of individual evidence were assessed using the Quality in Prognosis Studies (QUIPS) tool. Failure rates were extracted from included studies and pooled. Risk factors for failure were extracted and grouped. Moreover, we evaluated which risk factors were significantly associated with failure. RESULTS Thirty studies (8,586 native joints) were included in the final analysis. The overall pooled failure rate was 26% (95% CI 20 to 32%). The failure rate of arthroscopy and arthrotomy was 26% (95% CI 19 to 34%) and 24% (95% CI 17 to 33%), respectively. Seventy-nine potential risk factors were extracted and grouped. Moderate evidence was found for one risk factor (synovial white blood cell count), and limited evidence was found for five risk factors (i.e. sepsis, large joint infection, the volume of irrigation, blood urea nitrogen-test, and blood urea nitrogen/creatinine ratio). CONCLUSION A single surgical debridement fails to control bacterial arthritis of a native joint in approximately a quarter of all adult cases. Limited to moderate evidence exists that risk factors associated with failure are: synovial white blood cell count, sepsis, large joint infection, and the volume of irrigation. These factors should urge physicians to be especially receptive to signs of an adverse clinical course.
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Affiliation(s)
- Alex B. Walinga
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Tobias Stornebrink
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Kaj S. Emanuel
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
- Department of Orthopedic Surgery, CAPHRI Care and Public Health Research Institute, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Arthur J. Kievit
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Stein J. Janssen
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
| | - Gino M. M. J. Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Sport, Musculoskeletal Health, Amsterdam, The Netherlands
- Academic Center for Evidence Based Sports Medicine (ACES), Amsterdam, The Netherlands
- Amsterdam Collaboration for Health and Safety in Sports (ACHSS), International Olympic Committee (IOC) Research Center Amsterdam UMC), Amsterdam, The Netherlands
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13
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Post HK, Blankespoor MG, Ierulli VK, Morey TD, Schroeppel JP, Mulcahey MK, Vopat BG, Vopat ML. Review of Intra-Articular Use of Antibiotics and Antiseptic Irrigation and Their Systematic Association with Chondrolysis. Kans J Med 2023; 16:272-276. [PMID: 37954883 PMCID: PMC10635690 DOI: 10.17161/kjm.vol16.20357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 08/29/2023] [Indexed: 11/14/2023] Open
Abstract
Introduction Intra-articular antibiotics have been proposed as a treatment for septic arthritis to allow for high local concentrations without subjecting a patient to the toxicity/side effects of systemic therapy. However, there is concern for chondrotoxicity with intra-articular use of these solutions in high concentrations. The purpose of this systematic review was to evaluate the intra-articular use of antibiotics and antiseptic solutions, and to determine their association with chondrolysis following in vitro or in vivo administration. Methods A systematic review was conducted following PRISMA guidelines through PubMed, Clinical Key, OVID, and Google Scholar. Studies in English were included if they evaluated for chondrotoxicity following antibiotic exposure. Results The initial search resulted in 228 studies, with 36 studies meeting criteria. These 36 studies included manuscripts that studied 24 different agents. Overall, 7 of the 24 (29%) agents were non-chondrotoxic: minocycline, tetracycline, chloramphenicol, teicoplanin, pefloxacin, linezolid, polymyxin-bacitracin. Eight (33%) agents had inconsistent results: doxycycline, ceftriaxone, gentamicin, vancomycin, ciprofloxacin, ofloxacin, chlorhexidine, and povidone iodine. Chondrotoxicity was evident with 9 (38%) agents, all of which were also dose-dependent chondrotoxic based on reported estimated half maximal inhibitory concentrations (est. IC50): amikacin (est. IC50 = 0.31-2.74 mg/mL), neomycin (0.82), cefazolin (1.67-3.95), ceftazidime (3.16-3.59), ampicillin-sulbactam (8.64 - >25), penicillin (11.61), amoxicillin (14.01), imipenem (>25), and tobramycin (>25). Additionally, chondroprotective effects of doxycycline and minocycline were reported. Conclusions This systematic review identified agents that may be used in the treatment of septic arthritis. Nine agents should be avoided due to their dose-dependent chondrotoxic effects. Further studies are needed to clarify the safety of these medications for human intra-articular use.
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Affiliation(s)
- Hunter K Post
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Michael G Blankespoor
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Victoria K Ierulli
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA
| | - Tucker D Morey
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - J Paul Schroeppel
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Mary K Mulcahey
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL
| | - Bryan G Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, KS
| | - Matthew L Vopat
- Department of Orthopedic Surgery and Sports Medicine, University of Kansas School of Medicine, Kansas City, KS
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14
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Joo EJ, Kim B, Sohn KM, Kym S, Kim J. Administering Antibiotics for Less Than Four Weeks Increases the Risk of Relapse in Culture-Positive Septic Arthritis of Native Joints. J Clin Med 2023; 12:6808. [PMID: 37959273 PMCID: PMC10649866 DOI: 10.3390/jcm12216808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
(1) Objectives: This study investigated the optimal duration of antibiotic therapy and determined the risk factors associated with relapse in patients with culture-proven septic arthritis of native joints. (2) Methods: A retrospective review was conducted on patients aged ≥18 years diagnosed with native joint septic arthritis, with bacteria isolated from joints and/or blood. The exclusion criteria were prosthetic joint infections and cases with no identified microorganisms. The outcomes were assessed in the remission and relapse groups. (3) Results: Among 479 patients with native joint septic arthritis, 137 met the inclusion criteria, with a median follow-up duration of 2.7 years. The relapse rate was 9.5%, which mainly occurred within 30 days after antibiotic treatment completion. Compared with the remission group, the relapse group showed a significantly higher proportion of cases that received antibiotic therapy for ≤ 4 weeks (4.8% vs. 46.2%, p < 0.001), synovial fluid white blood cell (WBC) counts ≥150 × 103/mm3 (25.3% vs. 60.0%, p = 0.030), acute kidney injury (19.2% vs. 50%, p = 0.024), and extended-spectrum beta-lactamases-producing Enterobacteriaceae (0.8 vs. 15.4%, p = 0.024). Independent risk factors for relapse were determined as antibiotic therapy duration of ≤ 4 weeks (odds ratio (OR), 25.47; 95% confidence interval (CI), 1.57-412.33; p = 0.023) and synovial fluid WBC counts ≥150 × 103/mm3 (OR, 17.46; 95% CI, 1.74-175.62; p = 0.015). (4) Conclusions: Patients with native joint septic arthritis require vigilant monitoring for relapse, particularly when treated with antibiotic regimens administered for less than four weeks or when synovial aspirates exhibit elevated WBC counts at diagnosis.
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Affiliation(s)
- Eun-Jeong Joo
- Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (E.-J.J.); (B.K.)
| | - Bomi Kim
- Division of Infectious Diseases, Department of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; (E.-J.J.); (B.K.)
| | - Kyung Mok Sohn
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (K.M.S.); (S.K.)
| | - Sungmin Kym
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (K.M.S.); (S.K.)
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong-si 30099, Republic of Korea
| | - Jungok Kim
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon 35015, Republic of Korea; (K.M.S.); (S.K.)
- Division of Infectious Diseases, Department of Internal Medicine, Chungnam National University Sejong Hospital, Sejong-si 30099, Republic of Korea
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15
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Ruythooren F, Ghijselings S, Cools J, Depypere M, De Munter P, Metsemakers WJ, Vles G. Should treatment decisions in septic arthritis of the native hip joint be based on the route of infection? J Bone Jt Infect 2023; 8:209-218. [PMID: 38039332 PMCID: PMC10655073 DOI: 10.5194/jbji-8-209-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/21/2023] [Indexed: 12/03/2023] Open
Abstract
Background: Surgical management of septic arthritis (SA) of the hip aims at treating the infection by either preserving, resecting or replacing the joint. In some cases, joint preservation should be attempted, whereas other cases would benefit from immediate joint resection or replacement. Prognostic factors have been proposed to guide decision-making. We hypothesized that most of these factors can be simplified to three subgroups based on the route of infection: contiguous spreading, direct inoculation or hematogenous seeding. Methods: A total of 41 patients have been treated surgically for SA of the native hip at our tertiary hospital during the last 16 years. Medical records were studied, and various patient and disease characteristics were collated. Results: Significant differences between (1) level of fitness, (2) condition of the hip joint, (3) micro-organisms and (4) chance of femoral head preservation were found for patients with SA of the native hip resulting from the three aforementioned subgroups. Femoral head resection was necessary at one point in 85 % of patients. Patients with hematogenous infections of undamaged hips had a reasonable chance (53 %) of avoiding joint resection or replacement. Hip arthroplasty was performed on 46.3 % of patients, with an infection rate of 10.5 %. Conclusion: Patients with SA of the native hip resulting from contiguous spreading, hematogenous seeding or direct inoculation differ significantly and should be considered distinct clinical entities. Route of infection is directly related to the chance of femoral head preservation and should, therefore, guide decision-making. Only patients with hematogenous infection to a previously healthy hip had the possibility of femoral head preservation.
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Affiliation(s)
- Fred Ruythooren
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Stijn Ghijselings
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Jordi Cools
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
| | - Melissa Depypere
- Department of Laboratory Medicine, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Willem-Jan Metsemakers
- Department of Traumatology, University Hospitals Leuven - Gasthuisberg, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - George Vles
- Department of Orthopaedic Surgery, University Hospitals Leuven - Gasthuisberg, Leuven, Belgium
- Institute for Orthopaedic Research and Training (IORT), Catholic University Leuven, Leuven, Belgium
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16
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Feng W, Yao Z, Liu H, Zhu D, Song B, Wang Q. Clinical characteristics of and risk factors for poor outcomes in children with bacterial culture-negative septic arthritis of the hip. J Orthop Sci 2023:S0949-2658(23)00218-X. [PMID: 37597975 DOI: 10.1016/j.jos.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Septic arthritis of the hip is a serious infection in children. However, blood and joint fluid cultures are often negative, which makes the diagnosis and treatment challenging. We analyzed the clinical features of children with septic arthritis of the hip with negative bacterial cultures and identified the risk factors for poor outcomes. METHODS The clinical data of children with septic arthritis of the hip with negative bacterial cultures who were treated at our hospital from January 2010 to December 2020 were retrospectively analyzed. The clinical characteristics and outcomes of the culture-negative cohort were compared with those of children with positive bacterial cultures treated during the same period. Culture-negative patients were divided into a group with good outcomes and a group with poor outcomes. The differences between the two groups were compared. RESULTS Thirty-nine children with culture-negative septic arthritis of the hip were compared with 37 children with culture-positive sepsis. Compared with the culture-positive group, the culture-negative group had a significantly younger mean age and a significantly lower mean serum C-reactive protein concentration. Logistic regression analysis of culture-negative patients with good versus poor outcomes revealed that the independent risk factors for poor outcomes were an increased serum C-reactive protein concentration and prolonged time from onset to surgery. The cut-off values for predicting a poor outcome in the culture-negative group were a time from onset to surgery of greater than 21 days and a C-reactive protein concentration of greater than 23 mg/L. CONCLUSIONS Culture-negative septic arthritis of the hip has similar clinical features to culture-positive septic arthritis of the hip and can result in sequelae of varying severity. Therefore, active anti-infective and hip drainage therapy should be performed when children present with clinical symptoms, inflammatory marker concentrations, and imaging findings that are clinically diagnostic for septic arthritis of the hip. LEVEL OF EVIDENCE Level II, retrospective study.
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Affiliation(s)
- Wei Feng
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Ziming Yao
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Haonan Liu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Danjiang Zhu
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Baojian Song
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China
| | - Qiang Wang
- Department of Orthopedics, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56, Nalishi Road, Beijing 100045, PR China.
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17
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Straub J, Lingitz MT, Apprich S, Staats K, Windhager R, Böhler C. Early postoperative laboratory parameters are predictive of initial treatment failure in acute septic arthritis of the knee and shoulder joint. Sci Rep 2023; 13:8192. [PMID: 37210581 DOI: 10.1038/s41598-023-35384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
Septic arthritis is an orthopedic emergency potentially causing irreversible joint damage. However, the predictive value of potential risk factors such as early postoperative laboratory parameters remains uncertain. We investigated risk factors for initial surgical treatment failure using data from 249 patients (194 knees, 55 shoulders) treated for acute septic arthritis between 2003 and 2018. Necessity for further surgical intervention was defined as primary outcome. Demographic data, medical history, initial and postoperative laboratory parameters, Charlson Comorbidity Index (CCI), and Kellgren and Lawrence classification were collected. Two scoring systems were developed as tools for failure risk estimation after initial surgical irrigation and debridement. More than one intervention was necessary in 26.1% of cases. Treatment failure occurred significantly more often for those with longer symptom duration (p = 0.003), higher CCI grades (p = 0.027), Kellgren-Lawrence grade IV (p = 0.013), shoulder arthroscopy (p = 0.010), positive bacterial culture results (p < 0.001), slow postoperative CRP decline until day three (p = 0.032) and five (p = 0.015), reduced WBC-decline (p = 0.008), and lower hemoglobin (p < 0.001). Scores for third and fifth postoperative day achieved AUCs of 0.80 and 0.85, respectively. This study identified risk factors for treatment failure in patients with septic arthritis, suggesting that early postoperative laboratory parameters can guide further treatment.
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Affiliation(s)
- Jennifer Straub
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Marie-Therese Lingitz
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Kevin Staats
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christoph Böhler
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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18
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He M, Arthur Vithran DT, Pan L, Zeng H, Yang G, Lu B, Zhang F. An update on recent progress of the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis: a review. Front Cell Infect Microbiol 2023; 13:1193645. [PMID: 37249986 PMCID: PMC10214960 DOI: 10.3389/fcimb.2023.1193645] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 04/20/2023] [Indexed: 05/31/2023] Open
Abstract
Acute septic arthritis is on the rise among all patients. Acute septic arthritis must be extensively assessed, identified, and treated to prevent fatal consequences. Antimicrobial therapy administered intravenously has long been considered the gold standard for treating acute osteoarticular infections. According to clinical research, parenteral antibiotics for a few days, followed by oral antibiotics, are safe and effective for treating infections without complications. This article focuses on bringing physicians up-to-date on the most recent findings and discussions about the epidemiology, etiology, diagnosis, and treatment of acute septic arthritis. In recent years, the emergence of antibiotic-resistant, particularly aggressive bacterial species has highlighted the need for more research to enhance treatment approaches and develop innovative diagnosis methods and drugs that might combat better in all patients. This article aims to furnish radiologists, orthopaedic surgeons, and other medical practitioners with contemporary insights on the subject matter and foster collaborative efforts to improve patient outcomes. This review represents the initial comprehensive update encompassing patients across all age groups.
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Affiliation(s)
- Miao He
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Djandan Tadum Arthur Vithran
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Linyuan Pan
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haijin Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Guang Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Bangbao Lu
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Fangjie Zhang
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
- Department of Emergency Medicine, Xiangya Hospital, Central South University, Changsha, Hunan, China
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19
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Xiao S, Yi J, Zhang Y, Su M, Tang R. Mitigating Lactate-Associated Immunosuppression against Intracellular Bacteria Using Thermoresponsive Nanoparticles for Septic Arthritis Therapy. NANO LETTERS 2023; 23:3298-3308. [PMID: 37070785 DOI: 10.1021/acs.nanolett.3c00221] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Intracellular bacteria are the major contributor to the intractability of septic arthritis, which are sequestered in macrophages to undermine the innate immune response and avoid the antibacterial effect of antibiotics due to the obstruction of the cell membrane. Herein, we report a thermoresponsive nanoparticle, which consists of a phase-change material shell (fatty acids) and an oxygen-producing core (CaO2-vancomycin). Under external thermal stimulation, the shell of the nanoparticle transforms from a solid phase to a liquid phase. Then the CaO2-Vancomycin core is exposed to the surrounding aqueous solution to release vancomycin and generate Ca(OH)2 and oxygen, thereby depleting accumulated lactate to mitigate lactate-associated immunosuppression, stabilizing hypoxia-inducible factor-1α (HIF-1α) to enhance M1-like polarization of macrophages, and increasing reactive oxygen species (ROS) and reactive nitrogen species (RNS) production. This combined effect between the controlled release of antibiotics and enhancement of host innate immunity provides a promising strategy to combat intracellular bacteria for septic arthritis therapy.
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Affiliation(s)
- Shuya Xiao
- School of stomatology, Lanzhou University, Lanzhou 730000, People's Republic of China
| | - Jundan Yi
- School of stomatology, Lanzhou University, Lanzhou 730000, People's Republic of China
| | - Yueting Zhang
- School of stomatology, Lanzhou University, Lanzhou 730000, People's Republic of China
| | - Mingyue Su
- School of stomatology, Lanzhou University, Lanzhou 730000, People's Republic of China
| | - Rongbing Tang
- School of stomatology, Lanzhou University, Lanzhou 730000, People's Republic of China
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20
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Zhao N, Curry D, Evans RE, Isguven S, Freeman T, Eisenbrey JR, Forsberg F, Gilbertie JM, Boorman S, Hilliard R, Dastgheyb SS, Machado P, Stanczak M, Harwood M, Chen AF, Parvizi J, Shapiro IM, Hickok NJ, Schaer TP. Microbubble cavitation restores Staphylococcus aureus antibiotic susceptibility in vitro and in a septic arthritis model. Commun Biol 2023; 6:425. [PMID: 37069337 PMCID: PMC10110534 DOI: 10.1038/s42003-023-04752-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/24/2023] [Indexed: 04/19/2023] Open
Abstract
Treatment failure in joint infections is associated with fibrinous, antibiotic-resistant, floating and tissue-associated Staphylococcus aureus aggregates formed in synovial fluid (SynF). We explore whether antibiotic activity could be increased against Staphylococcus aureus aggregates using ultrasound-triggered microbubble destruction (UTMD), in vitro and in a porcine model of septic arthritis. In vitro, when bacterially laden SynF is diluted, akin to the dilution achieved clinically with lavage and local injection of antibiotics, amikacin and ultrasound application result in increased bacterial metabolism, aggregate permeabilization, and a 4-5 log decrease in colony forming units, independent of microbubble destruction. Without SynF dilution, amikacin + UTMD does not increase antibiotic activity. Importantly, in the porcine model of septic arthritis, no bacteria are recovered from the SynF after treatment with amikacin and UTMD-ultrasound without UTMD is insufficient. Our data suggest that UTMD + antibiotics may serve as an important adjunct for the treatment of septic arthritis.
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Affiliation(s)
- Neil Zhao
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dylan Curry
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rachel E Evans
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Selin Isguven
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Theresa Freeman
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
| | - John R Eisenbrey
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Flemming Forsberg
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jessica M Gilbertie
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - Sophie Boorman
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - Rachel Hilliard
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA
| | - Sana S Dastgheyb
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Priscilla Machado
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Maria Stanczak
- Department of Radiology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Marc Harwood
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Javad Parvizi
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
- Rothman Orthopaedic Institute, Philadelphia, PA, USA
| | - Irving M Shapiro
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Noreen J Hickok
- Department of Orthopaedic Surgery, Sidney Kimmel College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Thomas P Schaer
- Department of Clinical Studies, New Bolton Center, School of Veterinary Medicine, University of Pennsylvania, Kennett Square, PA, USA.
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21
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Stahl JP, Canouï E, Bleibtreu A, Dubée V, Ferry T, Gillet Y, Lemaignen A, Lesprit P, Lorrot M, Lourtet-Hascoët J, Manaquin R, Meyssonnier V, Pavese P, Pham TT, Varon E, Gauzit R. SPILF update on bacterial arthritis in adults and children. Infect Dis Now 2023; 53:104694. [PMID: 36948248 DOI: 10.1016/j.idnow.2023.104694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
In 2020 the French Society of Rhumatology (SFR) published an update of the 1990 recommendations for management of bacterial arthritis in adults. While we (French ID Society, SPILF) totally endorse this update, we wished to provide further information about specific antibiotic treatments. The present update focuses on antibiotics with good distribution in bone and joint. It is important to monitor their dosage, which should be maximized according to PK/PD parameters. Dosages proposed in this update are high, with the optimized mode of administration for intravenous betalactams (continuous or intermittent infusion). We give tools for the best dosage adaptation to conditions such as obesity or renal insufficiency. In case of enterobacter infection, with an antibiogram result "susceptible for high dosage", we recommend the requesting of specialized advice from an ID physician. More often than not, it is possible to prescribe antibiotics via the oral route as soon as blood cultures are sterile and clinical have symptoms shown improvement. Duration of antibiotic treatment is 6 weeks for Staphylococcus aureus, and 4 weeks for the other bacteria (except for Neisseria: 7 days).
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Affiliation(s)
- J P Stahl
- Université Grenoble Alpes, Maladies Infectieuses, 38700, France.
| | - E Canouï
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
| | - A Bleibtreu
- Maladies Infectieuseset Tropicales, Hôpital Pitié Salpêtrière, AP-HP Sorbonne Université, Paris France
| | - V Dubée
- Maladies Infectieuses et Tropicales, CHU d'Angers, Angers, France
| | - T Ferry
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - Y Gillet
- Urgences et Réanimation Pédiatrique, Hospices Civils de Lyon, Université Claude Bernard Lyon, France
| | - A Lemaignen
- Maladies Infectieuses, CHRU de Tours, Université de Tours, 37044, France
| | - P Lesprit
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - M Lorrot
- Pédiatrie Générale et Equipe Opérationnelle d'Infectiologie, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Pitié), Hôpital Armand Trousseau AP-HP Sorbonne Université, Paris France
| | | | - R Manaquin
- Maladies Infectieuses et Tropicales, GHSR , CHU de La Réunion, CRAtb La Réunion, Saint-Pierre, 97410, FRANCE
| | - V Meyssonnier
- Centre de Référence des Infections Ostéo-articulaires, GH Diaconesses Croix Saint-Simon, 75020, Paris, France; Service de Médecine Interne Générale, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - P Pavese
- Maladies Infectieuses, CHU Grenoble Alpes, 38043, France
| | - T-T Pham
- Maladies Infectieuses et Tropicales, Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Lyon), Hospices Civils de Lyon, Hôpital de la Croix-Rousse, 69004, Hospices Civils de Lyon, Lyon, France. Service des Maladies Infectieuses, Département de médecine, Hôpitaux Universitaires de Genève, Suisse
| | - E Varon
- Centre National de Référence des Pneumocoques, CRC-CRB, Centre Hospitalier Intercommunal de Créteil, 94000, Créteil, France
| | - R Gauzit
- Equipe mobile d'infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre de Référence des Infections Ostéo-Articulaires complexes (CRIOAc Cochin) APHP-CUP, Paris, France
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22
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Glassman I, Nguyen KH, Booth M, Minasyan M, Cappadona A, Venketaraman V. Atypical Staphylococcal Septic Arthritis in a Native Hip: A Case Report and Review. Pathogens 2023; 12:pathogens12030408. [PMID: 36986330 PMCID: PMC10051740 DOI: 10.3390/pathogens12030408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 02/24/2023] [Accepted: 03/01/2023] [Indexed: 03/08/2023] Open
Abstract
Septic arthritis is a synovial fluid and joint tissue infection with significant morbidity and mortality risk if not diagnosed and treated promptly. The most common pathogen to cause septic arthritis is Staphylococcus aureus, a Gram-positive bacterium. Although diagnostic criteria are in place to guide the diagnosis of staphylococcal septic arthritis, there is a lack of adequate sensitivity and specificity. Some patients present with atypical findings which make it difficult to diagnose and treat in time. In this paper, we present the case of a patient with an atypical presentation of recalcitrant staphylococcal septic arthritis in a native hip complicated by uncontrolled diabetes mellitus and tobacco usage. We review current literature on diagnosing S. aureus septic arthritis, novel diagnostic technique performance to guide future research and assist clinical suspicion, and current S. aureus vaccine development for at-risk patients.
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Affiliation(s)
- Ira Glassman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Kevin H. Nguyen
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Michelle Booth
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Marine Minasyan
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Abby Cappadona
- WesternU Health Patient Care Center, Western University of Health Sciences, Pomona, CA 91766, USA
| | - Vishwanath Venketaraman
- College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA 91766, USA
- Correspondence:
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23
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Hong CC, Chan MC, Wu T, Toh M, Tay YJ, Tan JH. Does concomitant gout in septic arthritis affect surgical outcomes? Injury 2023; 54:409-415. [PMID: 36351859 DOI: 10.1016/j.injury.2022.10.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aim to review and describe the proportion of patients with co-existing gout amongst patients with surgical treated septic arthritis, characterize their clinical presentation, outcomes and complications compared to patients with native joint septic arthritis. METHODS Sixty-one patients with surgically treated primary joint septic arthritis were identified from the period of January 2011 to December 2016. There were 13 (21.3%) patients with co-existing septic arthritis and crystal proven gout. Pertinent details such as demographics, comorbidities, clinical features on presentation, infection markers, number of surgeries, length of stay (LOS) in general and individual LOS in supportive care units, limb amputations, readmissions and mortality were reviewed. Multiple linear and logistic regression models were used to control for confounders during analysis. RESULTS The average age of patients was 60.8 years (range: 23-87 years). The patients with gout are associated with comorbidities such as being hypertensive, hyperlipidemia and renal impaired. They tend to present with ankle joint involvement (46.2% vs 8.3%; p = 0.004) while septic arthritis patients without gout tend to present with knee joint involvement (75% vs 46.2%; p = 0.046). In terms of complications, up to two thirds of them require supportive care in the High Dependency Unit and/or Intensive Care Unit during treatment (61.5% vs 29.2%; p = 0.031) and having gout with septic arthritis independently predicted a significant increase in LOS by an additional 12.6 days on average (95% CI: 2.11 - 23.03; p = 0.019). They are also more likely to end up with limb amputation (23.1% vs 0%; p = 0.008) on univariate analysis. CONCLUSION Gout accompanying septic arthritis in the same joint is potentially associated with major systemic and joint related sequela, complications in terms of prolonged hospital stay, need for complex care and risk for limb amputation. Our findings further indicate the value and need for well-designed prospective controlled cohort studies to explore the relationship between gout and septic arthritis.
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Affiliation(s)
- Choon Chiet Hong
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Ming Chun Chan
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Tianyi Wu
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Mingzhou Toh
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore
| | - Yuan Jie Tay
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
| | - Jiong Hao Tan
- Department of Orthopaedic Surgery, National University Hospital, National University Health System, Singapore.
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24
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Kwon H, Yu KE, Cahill SV, Alder KD, Dussik CM, Kim S, Sharma L, Back J, Oh I, Lee FY. Concurrent targeting of glycolysis in bacteria and host cell inflammation in septic arthritis. EMBO Mol Med 2022; 14:e15284. [PMID: 36354099 PMCID: PMC9728052 DOI: 10.15252/emmm.202115284] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 11/11/2022] Open
Abstract
Intracellular infiltration of bacteria into host cells complicates medical and surgical treatment of bacterial joint infections. Unlike soft tissue infections, septic arthritis and infection-associated inflammation destroy cartilage that does not regenerate once damaged. Herein, we show that glycolytic pathways are shared by methicillin-resistant Staphylococcus aureus (MRSA) proliferation and host inflammatory machinery in septic arthritis. MRSA readily penetrates host cells and induces proinflammatory cascades that persist after conventional antibiotic treatment. The glycolysis-targeting drug dimethyl fumarate (DMF) showed both bacteriostatic and anti-inflammatory effects by hindering the proliferation of intracellular MRSA and dampening excessive intraarticular inflammation. Combinatorial treatment with DMF and vancomycin further reduced the proliferation and re-emergence of intracellular MRSA. Combinatorial adjuvant administration of DMF with antibiotics alleviated clinical symptoms of septic arthritis by suppressing bacterial burden and curbing inflammation to protect cartilage and bone. Our results provide mechanistic insight into the regulation of glycolysis in the context of infection and host inflammation toward development of a novel therapeutic paradigm to ameliorate joint bioburden and destruction in septic arthritis.
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Affiliation(s)
- Hyuk‐Kwon Kwon
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Kristin E Yu
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA
| | - Sean V Cahill
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryWashington University School of MedicineSt. LouisMOUSA
| | - Kareme D Alder
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopedic SurgeryMayo ClinicRochesterMNUSA
| | - Christopher M Dussik
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
- Department of Orthopaedics and RehabilitationUniversity of RochesterRochesterNYUSA
| | - Sang‐Hun Kim
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Lokesh Sharma
- Section of Pulmonary, Critical Care and Sleep Medicine, Department of Internal MedicineYale School of MedicineNew HavenCTUSA
| | - Jungho Back
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Irvin Oh
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, School of MedicineYale UniversityNew HavenCTUSA
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25
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Yeo QY, Li ATC, Cuttilan AN, Low JCC, Ho SWL. Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee. Knee Surg Sports Traumatol Arthrosc 2022; 30:3776-3783. [PMID: 35604425 DOI: 10.1007/s00167-022-07001-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 05/04/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE Septic arthritis is an orthopaedic emergency with high morbidity and mortality. The aim of this study is to determine the risk factors associated with secondary surgery for septic arthritis of the native knee joint. METHODS This is a retrospective study reviewing all patients who underwent surgery for septic arthritis of the knee from 2012 to 2019 in a single institution. A total of 117 patients were recruited. Patients were divided into 2 groups: Group I (79/117, 67.5%) underwent one surgery and Group II (38/117, 32.5%) underwent more than one surgery. RESULTS Patients with a raised initial total white (TW) cell count of > 20 × 109/L had a significantly higher risk of secondary surgery. (Adjusted hazard ratio 2.42, p < 0.05) A decline of CRP level of less than 20% within 24 h from initial operation was also a risk for secondary surgery. (Adjusted hazard ratio 0.34, p < 0.01) Patients in group II also had significantly higher post-operative median TW cell count and neutrophil count. There was no significant difference in the offending microbe, surgical approach, and duration of operation from initial presentation between the groups. CONCLUSIONS Patients with septic arthritis of the native knee joint who present with raised initial total white cell count of > 20 × 109/L and decline of CRP level of less than 20% within 24 h from initial operation are at higher risk of secondary operation. In these patients, more aggressive treatment strategies and appropriate counselling on the risks of repeated surgery are recommended. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Quan You Yeo
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Ambrose Tsz Chun Li
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Amit Nirmal Cuttilan
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Jonathan Chee Chung Low
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
| | - Sean Wei Loong Ho
- Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore
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26
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Septic arthritis in a nonprosthetic joint due to Mycobacterium fortuitum: a case report. CURRENT ORTHOPAEDIC PRACTICE 2022. [DOI: 10.1097/bco.0000000000001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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27
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Arthroscopic Treatment Yields Lower Reoperation Rates than Open Treatment for Native Knee but Not Native Shoulder Septic Arthritis. Arthrosc Sports Med Rehabil 2022; 4:e1167-e1178. [PMID: 35747656 PMCID: PMC9210470 DOI: 10.1016/j.asmr.2022.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 04/16/2022] [Indexed: 11/21/2022] Open
Abstract
Purpose To compare the incidence, patient demographics, complication rates, readmission rates, and reoperation rates of open and arthroscopic surgery performed for septic arthritis in native knee and shoulder joints. Methods Records of patients who were diagnosed with native knee or shoulder septic arthritis and underwent open or arthroscopic irrigation and debridement (I&D) between 2015 and 2018 were queried from the PearlDiver Mariner Database. International Classification of Diseases 10th (ICD-10) diagnosis and procedure codes were used to identify patients and track reoperations. Reoperation procedures, including revision open and arthroscopic I&D, were analyzed at 1 month, 1 year, and 2 years. Complications, emergency department (ED) admissions, and hospital readmissions within 30 days were analyzed and compared between the open and arthroscopic cohorts. Results The query resulted with 1,993 patients who underwent knee I&D (75.3% arthroscopic, 24.7% open, P < .001) and 476 patients who underwent shoulder I&D (64.8% arthroscopic, 35.2% open, P < .001). One-month complication rates (11.6-22.7%) and hospital readmission rates (15.8-19.6%) were similar for arthroscopic and open treatment for knee and shoulder septic arthritis. Reoperation rates for revision I&D of the knee were higher after open compared to arthroscopic treatment at 1 month, 1 and 2 years (20.9% vs. 16.7%, 32.5% vs 27.6% and 34.1% vs. 29.4%, P < .05, respectively). For shoulder septic arthritis 1-month, 1-year, and 2-year reoperation rates were similar for open and arthroscopic treatment (16.0% vs 11.7%, 22.0% vs 19.3%, and 22.7% vs 20.0%, P = .57, respectively). Lastly, 6.7% of patients with native septic knee arthritis underwent subsequent arthroplasty by 2 years. Conclusion Arthroscopic treatment carries a lower reoperation rate than open surgery for knee septic arthritis, but in the shoulder, the risk for revision I&D is similar after arthroscopic or open surgery.
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28
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Kim KJ, Jeong HS, Ahn BH, Chung DM. Clinical Efficacy of the Antibiotic-Loaded Collagen Sponge During Arthroscopic Treatment of Acute Septic Arthritis of the Native Knee. Orthop J Sports Med 2022; 10:23259671221087189. [PMID: 35400138 PMCID: PMC8984851 DOI: 10.1177/23259671221087189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/10/2022] [Indexed: 11/15/2022] Open
Abstract
Background: To completely eliminate an infection, the antibiotic concentration must
exceed the minimum inhibitory concentration for the causative pathogens. The
antibiotic-loaded collagen sponge (ALCS) has been used to manage an
infection through a high local concentration of antibiotics. Purpose: To evaluate the clinical efficacy of ALCS in the arthroscopic treatment of
patients with acute septic arthritis of the native knee. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively reviewed the data for 132 consecutive patients
with acute septic arthritis of the knee who underwent arthroscopic
debridement between 2013 and 2019. Patients with a history of surgery in the
affected joint, concomitant osteomyelitis, or accompanying medical infection
were excluded. The study patients were divided into 2 groups based on the
use of ALCS during surgery. C-reactive protein (CRP) levels were temporally
measured to normalization and the duration of intravenous antibiotic
administration was recorded, and the mean length of hospital stay was
compared between the groups. Independent t test and
chi-square test were performed to assess differences between the groups, and
univariate analysis was used to analyze factors affecting recurrence of
septic arthritis. Results: Of the 132 patients, 88 were ultimately included in this study; 51 patients
were managed without ALCS and 37 were treated with ALCS. There were
statistically significant differences between groups in the mean period for
CRP-level normalization (15.2 ± 8.2 days [ALCS] vs 26.2 ± 14.7 days [without
ALCS]; P = .004), mean duration of intravenous antibiotic
use (18.4 ± 7.3 days [ALCS] vs 26.6 ± 16.1 days [without ALCS];
P = .046), and mean length of hospital stay (21.1 ±
11.6 days [ALCS] vs 30.3 ± 18.3 days [without ALCS]; P =
.045). The preoperative CRP level was the only significant risk factor for
recurrence or treatment failure after single arthroscopic debridement. Conclusion: The results of this study indicated that ALCS was able to reduce the duration
of CRP-level normalization, intravenous antibiotic use, and hospitalization
in patients who underwent arthroscopic irrigation and debridement for acute
septic arthritis of the native knee.
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Affiliation(s)
- Kook-Jong Kim
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Ho-Seung Jeong
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Byung-Hyun Ahn
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Dong-Min Chung
- Department of Orthopaedic Surgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
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29
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Lu V, Zhou A, Hussain HA, Thahir A, Krkovic M. Risk factors for septic arthritis and multiple arthroscopic washouts: minimum 2-year follow-up at a major trauma centre. Clin Rheumatol 2022; 41:2513-2523. [PMID: 35366159 PMCID: PMC9287235 DOI: 10.1007/s10067-022-06151-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/21/2022] [Accepted: 03/24/2022] [Indexed: 01/19/2023]
Abstract
Background Septic arthritis (SA) is a dangerous condition that requires emergency treatment. Managed by culture-specific antibiotics, irrigation, and debridement (I&D), some patients require repeat surgical treatment. The objectives were to determine the risk factors for SA and risk factors for repeat arthroscopic I&D in SA patients. We hypothesized that variables which directly or indirectly contributed to a larger infection burden would be associated with the development of SA and the need for repeat arthroscopic I&D. Methods All patients ≥ 18 years old presenting to the emergency department, orthopaedic and rheumatology clinics at our major trauma centre between January 2018 and January 2020 with a hot, swollen joint were retrospectively evaluated. Patients with previous trauma and metalwork in the affected joint, periprosthetic joint infection, previous joint arthroplasty surgery, soft tissue infection, missing data, transferred to another centre, diagnosis not concerning the joint, and < 24-month follow-up were excluded. Two hundred eleven patients were included (SA: 28; pseudogout: 32; gout: 50; others: 101). Variables of interest in the 3-month period preceding the diagnosis of SA were compared between SA and non-SA patients using univariable analysis. A multivariable logistic regression model was formed using covariates with corresponding univariable tests of p < 0.200. Similar analyses were performed to compare SA patients with multiple washouts/procedures with those with one washout/procedure. Results Multivariable analysis showed multiple risk factors for SA, namely rheumatoid arthritis (RA) (OR: 3.4; 95% CI: 1.2–10.0; p = 0.023); skin infection (OR: 3.3; 95% CI: 1.2–9.0; p = 0.017), liver disease (OR: 9.9; 95% CI: 2.2–43.9; p = 0.003), knee joint involvement (OR: 3.5; 95% CI: 1.3–9.4; p = 0.014), and use of immunosuppressive medication (OR: 3.5; 95% CI: 1.2–10.6; p = 0.027). Risk factors for multiple washouts included synovial WBC levels > 10.5 × 109 cells/L (OR: 3.0; 95% CI: 2.3–38.8; p = 0.009) and RA (OR: 3.5; 95% CI: 1.9–66.3; p = 0.017). Conclusions These findings suggest that prophylactic actions against septic arthritis should be targeted at patients with liver disease, RA, or skin infection. Repeat arthroscopic I&D of septic joints may be needed, especially in patients with synovial WBC levels > 10.5 × 109 cells/L and RA. Key Points • The risk factors for septic arthritis determined in this study are rheumatoid arthritis, skin infection, liver disease, knee joint involvement, and immunosuppressant usage. • Some septic arthritis patients need multiple rounds of arthroscopic irrigation and debridement. The risk factors for this are a synovial WBC count > 10.5 × 109 cells/L and rheumatoid arthritis. |
Supplementary Information The online version contains supplementary material available at 10.1007/s10067-022-06151-w.
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Affiliation(s)
- Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK. .,Christ's College, St. Andrew's Street, Cambridge, CB2 3BU, UK.
| | - Andrew Zhou
- School of Clinical Medicine, University of Cambridge, Cambridge, CB2 0SP, UK
| | | | - Azeem Thahir
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
| | - Matija Krkovic
- Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK
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Radhamony NG, Walkay S, Palaneer S, Hamadto M. Predictors of failure after initial arthroscopic washout in septic arthritis of native knee joint- a retrospective analysis. Ann Med Surg (Lond) 2022; 74:103269. [PMID: 35242307 PMCID: PMC8858759 DOI: 10.1016/j.amsu.2022.103269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/07/2022] [Accepted: 01/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acute septic arthritis of the knee is an orthopaedic emergency requiring prompt debridement and washout to reduce infection. However, more than one washout procedure may be required to eradicate infection. This study was performed to analyse the factors associated with the failure of a single arthroscopic washout. Methods This is a retrospective analysis of 78 patients with septic arthritis of the knee over 6 years from January 2015 from a single trauma centre. We analysed the variables like patient demographic factors, comorbidities, laboratory parameters and various operative and non-operative factors with regard to the outcome after a single arthroscopic washout. Statistical analysis using univariate and multivariate logistic regression analysis were performed to identify the variables associated. Results Out of the 78 patients who underwent arthroscopic washout for a diagnosis of septic arthritis, 31 patients (39.74%) had failure of a single arthroscopic washout, with six patients (7.69%) requiring two additional washouts and one patient (1.28%) requiring three additional washouts to eradicate infection. Statistical analysis identified high temperature at presentation (p value 0.084), BMI >45 (p value 0.025), high CRP (0.014), high neutrophil count (p value 0.113) and high creatinine (p value 0.111) as the predictors of failure of a single arthroscopic washout. Conclusion A high failure rate (39.74%) was seen with a single arthroscopic washout procedure. A high BMI, elevated CRP, higher temperature at presentation, elevated neutrophil count were identified as the predictors of failure of a single arthroscopic washout for septic arthritis of the knee in our study. In septic arthritis of the knee, more than one arthroscopic washout may be required to eradicate infection. Our study evaluated the repeated arthroscopic washout rates in hematogenous septic arthritis of native knee joint. High temperature at presentation, high CRP, high BMI and high creatinine were associated with repeated infection.
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Balato G, de Matteo V, Ascione T, de Giovanni R, Marano E, Rizzo M, Mariconda M. Management of septic arthritis of the hip joint in adults. A systematic review of the literature. BMC Musculoskelet Disord 2021; 22:1006. [PMID: 34856966 PMCID: PMC8641144 DOI: 10.1186/s12891-021-04843-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The septic arthritis of the hip is a complex condition characterized by a variety of clinical presentations, a challenging diagnosis and different surgical treatment options, including arthroscopy, resection arthroplasty and one and two-stage total hip replacement. Each technique reports variable results in terms of infection eradication rate. The aim of this systematic review is to compare the most relevant studies available in current literature and to assess if a better treatment outcome can be predicted based on the microbiology, history, and type of infection (active vs quiescent) of each case. METHODS A systematic review of the literature was performed in accordance with the PRISMA guidelines, including the studies dealing with the treatment of hip septic arthritis in adult patients. Electronic databases, namely the MEDLINE, Scopus, and Web of Science, were reviewed using a combination of following keywords "septic arthritis" AND "hip joint" OR "hip" AND "adult". RESULTS The total number of patients included in this review was 1236 (45% of which females), for 1238 hips. The most common pathogen isolated was Staphylococcus aureus in its Methicillin-sensitive variant ranging from 2 to 37% of cases. Negative cultures were the second most common finding. It was also differentiated the type of infection of the hip, 809 and 417 patients with active and quiescent hip infection, respectively, were analyzed. Eradication rates for two-stage revision arthroplasty ranged between 85 and 100%, for one-stage approach between 94 and 100%, while for arthroscopic debridement/lavage between 89 and 100%. CONCLUSION Staphylococcus aureus is the most common microorganism isolated followed by culture negative infections. Arthroscopic, one and two stage procedures can be effective in the treatment of hip septic arthritis when the indication is consistent with the type of infection retrieved. LEVEL OF EVIDENCE IV, therapeutic study.
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Affiliation(s)
- Giovanni Balato
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Vincenzo de Matteo
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Tiziana Ascione
- Service of Infectious Diseases, AORN Cardarelli Hospital, Naples, Italy
| | - Roberto de Giovanni
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Ernesto Marano
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Maria Rizzo
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
| | - Massimo Mariconda
- Department of Public Health, Orthopedic Unit, “Federico II” University, Via Sergio Pansini, 5, 80130 Naples, Italy
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Osteomyelitis on MR imaging as a key predictor of recurrent septic arthritis of the shoulder. Eur Radiol 2021; 32:1419-1428. [PMID: 34642809 DOI: 10.1007/s00330-021-08238-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 07/15/2021] [Accepted: 08/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To investigate the clinical and radiologic predictors of postoperative recurrent septic arthritis of the shoulder (SAS) using multivariable analysis. METHODS Forty-three patients (mean age, 65 years; 24 women) who underwent surgery for SAS between January 2011 and October 2019 were retrospectively enrolled. An orthopedic surgeon assessed clinical (age, sex, comorbidity, duration from symptom onset to MR imaging and surgery, surgical method, antibiotic usage), laboratory (serum white blood cell [WBC] count, C-reactive protein [CRP] level, synovial cell count), and surgical findings (culture/biopsy results). Two musculoskeletal radiologists evaluated MR imaging findings (bone marrow [reactive bone marrow edema, osteomyelitis, osteochondral erosion] and soft tissue [synovitis, bursitis, muscle edema, abscess] abnormalities). Recurrent SAS was evaluated at ≥ 12 months postoperatively. Univariable and multivariable analyses were performed to determine the best predictor of recurrent SAS. RESULTS The overall recurrent SAS rate was 33% (14/43). On univariable analysis, mean age (without recurrence vs. recurrence: 68 vs. 59 years, p = .04), mean duration from symptom onset to surgery (18 vs. 25 days, p = .02), serum WBC count (12,000 vs. 9,000 cells/mL3, p = .04), CRP level (13 vs. 6 mg/L, p = .01), and osteomyelitis on MR imaging (p < .01 for both readers) significantly differed between patients with and without recurrence; on multivariable analysis, only osteomyelitis on MR imaging was significantly associated with recurrent SAS for both readers (p = .02 and .01 for each reader respectively). The inter-reader agreement was good (κ = .62-1.0) for all MR imaging findings, except for muscle edema (fair, κ = .37). CONCLUSION Osteomyelitis on MR imaging was the best predictor of recurrent SAS. KEY POINTS • Osteomyelitis on preoperative MR imaging was the best predictor associated with recurrent septic arthritis of the shoulder on multivariable analysis including clinical, laboratory, and MR findings. • In multivariable analyses focused on each bone marrow abnormality, with adjustment for clinical and laboratory parameters, the presence of reactive bone marrow edema and osteochondral erosion on MR imaging showed no significant association with recurrent septic arthritis of the shoulder.
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Pietsch M, Hochegger M, Djahani O, Hofmann S, Mlaker G, Eder-Halbedl M, Hofstätter T. A two-stage approach to primary TKA using articulating antibiotic-loaded spacers improve function and eradicate infection in septic arthritic knees. Knee Surg Sports Traumatol Arthrosc 2021; 29:3186-3194. [PMID: 32556435 DOI: 10.1007/s00167-020-06106-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Accepted: 06/11/2020] [Indexed: 12/01/2022]
Abstract
PURPOSE The treatment of an infected arthritic knee might be challenging. The failure rate has been reported to be high for open or arthroscopic debridement. A subsequently high rate of infection has been noted in these patients undergoing primary total knee arthroplasty (TKA). In the present study, a two-stage approach using an articulating spacer was used. The hypothesis was that the procedure would eradicate the infection and improve pain and function in these patients. METHODS A total of 16 consecutive patients were enrolled in this retrospective study. The mean follow-up time was 6.1 years (range 2.0-9.9 years). Patients with advanced osteoarthritis and infection of the knee were included. All patients had previously undergone one or more failed arthroscopic or open procedures for the eradication of infection. All patients received the same homemade metal-on-plastic articulating antibiotic spacer. Double antibiotic therapy was given for 2 weeks intravenously and orally for 4 weeks. TKA implantation was performed 6 weeks after the first stage. RESULTS The infection was eradicated without recurrence in all patients. The functional results were significantly improved, and pain was significantly reduced after spacer and TKA implantation. The mean amount of knee flexion was 95 ± 30° preoperatively, and it increased to 109 ± 14° (p = 0.012) after spacer implantation and to 119 ± 10° (p = 0.002) after TKA implantation. The mean KSS objective was 58 ± 12 preoperatively, and it increased to 75 ± 14 (p < 0.0001) after spacer implantation and to 96 ± 3 (p < 0.0001) after TKA implantation. The mean KSS function was 17 ± 11 preoperatively, and it increased to 46 ± 10 (p < 0.0001) after spacer implantation and to 86 ± 6 (p < 0.0001) after TKA implantation. The mean VAS score was 65 ± 11 preoperatively, and it decreased to 2 ± 4 (p < 0.0001) after spacer implantation and to 1 ± 2 (p < 0.0001) after TKA implantation. CONCLUSION The two-stage procedure for the treatment of infected arthritic knees after failed eradication surgery was effective in all patients. Using an antibiotic articulating metal-on-plastic cement spacer showed improved functional results between the stages and at the final follow-up. No intra- or postoperative complications occurred.
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Affiliation(s)
- M Pietsch
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria.
| | - M Hochegger
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - O Djahani
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - S Hofmann
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - G Mlaker
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - M Eder-Halbedl
- Department of Orthopaedic Surgery, Orthopaedic Hospital Stolzalpe (LKH Murtal), Stolzalpe 38, 8852, Stolzalpe, Austria
| | - Th Hofstätter
- Department of Orthopaedic and Trauma Surgery, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria
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Kwon HK, Lee I, Yu KE, Cahill SV, Alder KD, Lee S, Dussik CM, Back J, Choi J, Song L, Kyriakides TR, Lee FY. Dual therapeutic targeting of intra-articular inflammation and intracellular bacteria enhances chondroprotection in septic arthritis. SCIENCE ADVANCES 2021; 7:eabf2665. [PMID: 34172438 PMCID: PMC8232912 DOI: 10.1126/sciadv.abf2665] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/12/2021] [Indexed: 05/10/2023]
Abstract
Bacterial infections involving joints and vital organs represent a challenging clinical problem because of the two concurrent therapeutic goals of bacterial eradication and tissue preservation. In the case of septic arthritis, permanent destruction of articular cartilage by intense host inflammation is commonly seen even after successful treatment of bacterial infection. Here, we provide scientific evidence of a novel treatment modality that can protect articular cartilage and enhanced eradication of causative bacteria in septic arthritis. Locally delivered cell-penetrating antibiotics such as rifampicin effectively eradicate intracellular reservoirs of methicillin-resistant Staphylococcus aureus within joint cells. Furthermore, mitigation of intra-articular inflammation by targeting the NLRP3 (nucleotide-binding oligomerization domain-, leucine-rich repeat- and pyrin domain-containing 3) inflammasome protects articular cartilage from damage in a murine model of knee septic arthritis. Together, concurrent mitigation of intra-articular inflammation and local adjuvant targeting of intracellular bacteria represents a promising new therapeutic strategy for septic arthritis.
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Affiliation(s)
- Hyuk-Kwon Kwon
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Inkyu Lee
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Kristin E Yu
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Sean V Cahill
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Kareme D Alder
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Saelim Lee
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Christopher M Dussik
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - JungHo Back
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA
| | - Jeongjoon Choi
- Department of Microbial Pathogenesis, Yale School of Medicine, 295 Congress Ave., New Haven, CT 06536, USA
| | - Lee Song
- Department of Orthopedics Surgery, Columbia University, New York, NY 10032, USA
| | - Themis R Kyriakides
- Department of Biomedical Engineering, Yale University, New Haven, CT 06520, USA
- Department of Pathology, Yale School of Medicine, New Haven, CT 06520, USA
| | - Francis Y Lee
- Department of Orthopaedics and Rehabilitation, Yale University School of Medicine, 800 Howard Ave., New Haven, CT 06510, USA.
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Acosta-Olivo C, Vilchez-Cavazos F, Blázquez-Saldaña J, Villarreal-Villarreal G, Peña-Martínez V, Simental-Mendía M. Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis. INTERNATIONAL ORTHOPAEDICS 2021; 45:1947-1959. [PMID: 33939020 DOI: 10.1007/s00264-021-05056-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/21/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE To evaluate the efficacy of arthrotomy, when compared with arthroscopy, in the treatment of adults with septic arthritis of any joint. METHODS MEDLINE, EMBASE, and Scopus were searched to identify studies comparing arthrotomy and arthroscopy as therapeutic approaches in patients with septic arthritis of any joint. The main outcome was the re-infection rate. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index. RESULTS Twenty studies with 10,249 patients treated by arthrotomy or arthroscopy were evaluated. We observed a significant lower risk of re-infection (odds ratio [OR], 1.35 [95% CI, 1.16-1.58]; p = 0.0002) and complications (OR, 1.32 [95% CI, 1.12-1.55]; p = 0.001) rate as well as less hospital stay (mean difference [MD], 0.57 days [95% CI, 0.10-1.05]; p = 0.02) favouring arthroscopic intervention. The subanalysis indicated that patients with knee (OR, 1.50 [95% CI, 1.17-1.92]; p = 0.001) and shoulder (OR, 1.24 [95% CI, 1.00-1.53]; p = 0.04) septic arthritis intervened by arthrotomy had a higher risk of re-infection. A lower number of hospitalization days (MD, 0.89 days [95% CI, 0.31-1.47]; p = 0.003) and a lower risk for complications (OR, 1.26 [95% CI, 1.04-1.52]; p = 0.02) were observed in patients treated with arthroscopy after septic knee arthritis. CONCLUSIONS Available evidence suggests that patients with septic arthritis of the knee and shoulder treated by arthroscopy have less risk of re-infection than those treated by arthrotomy. The quality of the body of evidence is still insufficient to reach reliable conclusions. PROSPERO TRIAL REGISTRATION NUMBER CRD42020176044. Date registration: April 28, 2020.
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Affiliation(s)
- Carlos Acosta-Olivo
- Orhtopedics and Truamatology Service, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Fco. I. Madero and José Eleuterio González, 64460, Monterrey, México
| | - Félix Vilchez-Cavazos
- Orhtopedics and Truamatology Service, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Fco. I. Madero and José Eleuterio González, 64460, Monterrey, México
| | - Jaime Blázquez-Saldaña
- Orhtopedics and Truamatology Service, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Fco. I. Madero and José Eleuterio González, 64460, Monterrey, México
| | - Gregorio Villarreal-Villarreal
- Orhtopedics and Truamatology Service, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Fco. I. Madero and José Eleuterio González, 64460, Monterrey, México
| | - Victor Peña-Martínez
- Orhtopedics and Truamatology Service, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Fco. I. Madero and José Eleuterio González, 64460, Monterrey, México
| | - Mario Simental-Mendía
- Orhtopedics and Truamatology Service, University Hospital "Dr. José E. González", Universidad Autonoma de Nuevo Leon, Fco. I. Madero and José Eleuterio González, 64460, Monterrey, México.
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Takahashi R, Kajita Y, Harada Y, Iwahori Y, Deie M. Factors affecting the outcome of septic arthritis of the shoulder joint with arthroscopic management. J Orthop Sci 2021; 26:381-384. [PMID: 32723522 DOI: 10.1016/j.jos.2020.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Good results have been reported with arthroscopic therapy of septic arthritis of the shoulder; however, few studies have focused on the risk factors for failure of arthroscopic surgery. The purpose of this study was to identify the risk factors affecting the recurrence or death post-surgery in cases of septic arthritis of the shoulder. METHODS We retrospectively assessed the records of patients who underwent surgical treatment for septic arthritis of the shoulder between 2009 and 2019. Patients were divided into 2 groups based on complete recovery, recurrence, or death after a single arthroscopic surgery: the eradicated group and the recurred/death group. To identify risk factors for the failure of arthroscopic surgery for septic arthritis of the shoulder, the following parameters were considered: age, sex, presentation of a rotator cuff tear, the arthroscopic staging of the infection, diabetes mellitus, the causative organism, preoperative white blood cell count, and C-reactive protein level in blood. We compared two groups with respect to the presence of potential risk factors. RESULTS This study included 22 patients with a mean age of 67.9 years. Septic arthritis of the shoulder was eradicated completely with a single arthroscopic surgery in 17 patients (77.3%). However, failure of the surgery resulting in recurrence or death was observed in 5 patients (22.7%). No significant differences were observed in other parameters between the two groups except for the causative organism. Methicillin-resistant Staphylococcus aureus was found in 1 patient (5.9%) in the eradicated group. On the other hand, Methicillin-resistant S. aureus was found in 3 patients (60%) in the recurred/death group (p = 0.024). CONCLUSION Most patients with septic arthritis of the shoulder are effectively treated with a single arthroscopic surgery. This study suggests that Methicillin-resistant S. aureus as the causative organism may be the most important prognostic factor in these cases.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan; Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan.
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Fukushima K, Uekusa Y, Koyama T, Ohashi Y, Uchiyama K, Takahira N, Takaso M. Efficacy and safety of arthroscopic treatment for native acute septic arthritis of the hip joint in adult patients. BMC Musculoskelet Disord 2021; 22:318. [PMID: 33794856 PMCID: PMC8015061 DOI: 10.1186/s12891-021-04195-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Accepted: 03/24/2021] [Indexed: 11/29/2022] Open
Abstract
Background As septic arthritis is time-dependent and has a propensity for irreversible joint damage, early diagnosis and treatment are needed. Frequently, adult patients with septic arthritis cannot undergo invasive surgery because of comorbidities and a weakened immune system. Hip arthroscopic irrigation and debridement for native acute septic arthritis of the hip joint have been performed as the first choice of treatment for patients of all ages. This study aimed to assess the efficacy and safety of arthroscopic management for native acute septic arthritis of the hip joint in adult patients. Methods Five adult patients (mean age, 46.2 years; all male) were retrospectively reviewed. Immediately after diagnosis, all patients underwent hip arthroscopic irrigation, debridement with synovectomy, and drainage. Partial weight-bearing was permitted once the C-reactive protein level normalised to < 1.0 mg/dl. Preoperative comorbidities, bacterial culture results, surgical complications, duration of hospital stay, time-to-confirmed normalisation of the C-reactive protein level, and recurrence incidence were evaluated. Results All patients had comorbidities, and the cultured microorganisms differed among cases. There were no complications related to arthroscopic surgery. All patients achieved confirmed C-reactive protein normalisation within an average of 69.8 days, and there was no recurrence during the follow-up period (mean, 40.2 months; range, 16–60 months). Conclusion Arthroscopic management for native acute septic arthritis of the hip joint is a safe and effective procedure in adult patients.
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Affiliation(s)
- Kensuke Fukushima
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Yui Uekusa
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Tomohisa Koyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Yoshihisa Ohashi
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Katsufumi Uchiyama
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Naonobu Takahira
- Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masashi Takaso
- Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
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Elsissy JG, Liu JN, Wilton PJ, Nwachuku I, Gowd AK, Amin NH. Bacterial Septic Arthritis of the Adult Native Knee Joint: A Review. JBJS Rev 2021; 8:e0059. [PMID: 31899698 DOI: 10.2106/jbjs.rvw.19.00059] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
» Acute bacterial septic arthritis of the knee is an orthopaedic emergency and, if left untreated, can result in substantial joint degradation.
» Important risk factors for development of septic arthritis include age of >60 years, recent bacteremia, diabetes, cancer, cirrhosis, renal disease, drug or alcohol abuse, a history of corticosteroid injection, a recent injury or surgical procedure, a prosthetic joint, and a history of rheumatoid arthritis.
» The diagnosis is primarily based on history and clinical presentation of a red, warm, swollen, and painful joint with limited range of motion. Laboratory values and inflammatory markers from serum and joint fluid may serve as adjuncts when there is clinical suspicion of septic arthritis.
» The initial and general antibiotic regimen should cover methicillin-resistant Staphylococcus aureus and gram-negative and gram-positive organisms. The antibiotic regimen should be specified following the culture results of the infected joint.
» Operative management involves either arthrotomy or arthroscopy of the knee with thorough irrigation and debridement of all infected tissue. The Gächter classification is useful in establishing a prognosis or in determining the need for an extensive debridement.
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Affiliation(s)
| | - Joseph N Liu
- Loma Linda University Medical Center, Loma Linda, California
| | - Peter J Wilton
- Loma Linda University Medical Center, Loma Linda, California
| | - Ikenna Nwachuku
- Loma Linda University School of Medicine, Loma Linda, California
| | - Anirudh K Gowd
- Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina
| | - Nirav H Amin
- Veterans Affairs Loma Linda, Loma Linda, California
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Arthroscopic resection arthroplasty for septic hip with osteonecrosis of the femoral head in patients with multiple comorbidities: A report of two cases. J Orthop Sci 2021; 26:186-189. [PMID: 30001918 DOI: 10.1016/j.jos.2018.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 04/10/2018] [Accepted: 05/16/2018] [Indexed: 11/21/2022]
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Mid- to Long-Term Outcomes After Deep Infections After Arthroscopic Rotator Cuff Repair. Arthrosc Sports Med Rehabil 2020; 2:e315-e320. [PMID: 32875294 PMCID: PMC7451929 DOI: 10.1016/j.asmr.2020.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 03/26/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To review clinical and subjective outcomes in patients with deep infections after arthroscopic rotator cuff repair. Methods All patients in whom deep infections developed after arthroscopic rotator cuff repair at a single center between 2002 and 2016 were retrospectively reviewed. Demographic data, clinical and microbiological findings, and treatment were analyzed. Clinical and subjective outcomes included the Constant score, visual analog scale score for pain, American Shoulder and Elbow Surgeons score, and Simple Shoulder Test score. Results Thirty patients could be identified and included in the study. The most commonly isolated pathogens were Staphylococcus epidermidis (36.7%) and Cutibacterium acnes (30.0%). In 26 of 30 patients (86.7%), the infection was treated initially with an open surgical approach, whereas 4 patients (13.3%) underwent arthroscopic revision. A transosseous rotator cuff repair could be performed in 20.0% of patients. A single reoperation was sufficient in 80% of patients, whereas 13.3% required 2 revisions and 6.7% required 3. At the final follow-up of 8.3 years (range, 4-14 years), 26 patients (1 woman and 25 men) were available for outcome evaluation. Significant improvement from the initial surgical procedure to final follow-up was detected in the Constant score (25.7 vs 65.7, P < .001), visual analog scale score for pain (7.0 vs 1.7, P < .001), American Shoulder and Elbow Surgeons score (38.0 vs 76.7, P < .001), and Simple Shoulder Test score (4.0 vs 8.3, P < .001). Conclusions Patients with deep infections after arthroscopic rotator cuff repair showed moderate mid- to long-term outcomes. Level of Evidence Level IV, therapeutic case series.
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Paz Z, Fowler ML, Zhu C, Lieber SB, Moore A, Shmerling RH. Patients with surgically treated culture-negative native joint septic arthritis have less severe disease and better outcomes. Infect Dis (Lond) 2020; 52:713-720. [PMID: 32580675 DOI: 10.1080/23744235.2020.1784455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Patients with culture-negative septic arthritis patients are often treated surgically but might be successfully managed medically. We compared clinical characteristics and outcomes in patients with culture negative and culture positive native joint monoarticular septic arthritis.Methods: This retrospective study included all patients age ≥18 years admitted to a single, tertiary-care hospital between 1998 and 2015 with native joint monoarticular SA and treated with antibiotics and surgery.Results: Of 306 patients, 85 had negative and 221 had positive cultures. Mean C-reactive protein (p < .01) and mean percentage of peripheral polymorphonuclear cells (p = .01) were higher in culture-positive patients who had higher intensive care unit admission rates (16.7% vs. 4.7%, respectively, [p < .01]), longer length of hospital stay (11.4 vs. 7.1 days, respectively, [p < .01]) and higher mortality rates within 30 days (0% vs. 5.5%, respectively,[p = .02]). Of culture-negative patients, 28.6% received an alternative diagnosis within one year. Logistic regression models showed that culture positive patients had an adjusted odds ratio for length of stay of 4.5 (2.69, 7.51), intensive care unit admission of 5.76 (1.31, 25.22), discharge to rehabilitation of 4.7 (2.28, 9.71) and an alternative diagnosis within one year of 0.05 (0.02, 0.15) compared to culture negative patients.Conclusion: Patients with culture-negative native joint septic arthritis had less severe disease, better outcomes and higher rates of alternative diagnosis within one year than patients with positive cultures.
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Affiliation(s)
- Ziv Paz
- Beth Israel Deaconess Medical Center, Boston, MA, USA
| | | | - Clara Zhu
- Boston University School of Medicine, Boston, MA, USA
| | | | - Andrew Moore
- Harvard Medical School, Cambridge Health Alliance, Cambridge, MA, USA
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Chow EMW, Lau JKY, Liyeung LLC, Chau WW, Mak MCK, Tse WL, Ho PC. Functional Outcome for Arthroscopic Treatment of Septic Arthritis of the Wrist. J Wrist Surg 2020; 9:190-196. [PMID: 32509421 PMCID: PMC7263864 DOI: 10.1055/s-0039-3402423] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 11/13/2019] [Indexed: 10/25/2022]
Abstract
Background Septic arthritis is a potentially joint-destructing condition if not treated properly. Septic wrist accounts for ∼5% of all septic arthritis. Arthroscopic lavage is a well-documented treatment for septic arthritis of the knee, hip, or shoulder only. Previous studies on septic wrist were limited to case reports or retrospective studies focusing on open treatment, and functional outcome was seldom documented. Our study aims to evaluate the effectiveness of arthroscopic treatment and to investigate the functional outcome. Materials and Methods Patients were retrospectively reviewed over a period of 10 years. Parameters including age, gender, history of prior injury, duration of symptoms, joint aspirates and intraoperative tissue culture, radiological and arthroscopic findings, antibiotics used, number of operations, and hospital stay were reviewed. Functional outcomes were evaluated with QuickDASH (disabilities of the arm, shoulder, and hand) score. Results From 2007 to 2016, 14 patients (15 septic wrists) underwent arthroscopic surgery. One patient had bilateral involvement. The average age was 63.9 years and the average duration of symptoms was 6.08 days. Average follow-up time was 10 months. All except two patients (85.7%) responded to single arthroscopic treatment. Two required subsequent operations for concomitant tenosynovitis. There were no major complications. The most common isolated organism was Staphylococcus aureus . Only one case had severe joint erosion during follow-up. The average QuickDASH score was 19.7. Duration of symptoms 5 days or more before admission was associated with higher QuickDASH score ( p = 0.04). Conclusion Early arthroscopic treatment should be considered for all patients admitted for septic arthritis of the wrist if not contraindicated. Level of Evidence This is a Level III, retrospective review.
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Affiliation(s)
- Esther M. W. Chow
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
| | - Jimmy K. Y. Lau
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
| | - Lucci L. C. Liyeung
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
| | - W. W. Chau
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
| | - Michael C. K. Mak
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
| | - W. L. Tse
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
| | - P. C. Ho
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
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Joo YB, Lee WY, Shin HD, Kim KC, Kim YK. Risk factors for failure of eradicating infection in a single arthroscopic surgical procedure for septic arthritis of the adult native shoulder with a focus on the volume of irrigation. J Shoulder Elbow Surg 2020; 29:497-501. [PMID: 31542323 DOI: 10.1016/j.jse.2019.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Septic arthritis of a native joint is relatively rare but is still a challenging and important orthopedic emergency. Most previous reports have focused on the clinical outcomes rather than the risk factors for failure in arthroscopic surgery. METHODS We retrospectively reviewed the records of patients with septic monoarthritis of the shoulder who underwent arthroscopic irrigation and débridement between January 2007 and January 2019. All patients were divided into 2 groups according to recurrence after a single arthroscopic surgical procedure: eradicated group or recurred group. To identify risk factors affecting the recurrence of septic arthritis of the shoulder after arthroscopic surgery, the following parameters were considered: age; sex; involved side; presentation of rotator cuff tear; volume of irrigation; bacterial organism involved; preoperative erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count in blood and joint fluid; diabetes mellitus; and hypertension. We compared the eradicated and recurred groups regarding the presence of potential risk factors. RESULTS The study included 97 patients with a mean age of 61 years. Septic arthritis of the shoulder was eradicated completely with a single arthroscopic surgical procedure in 85 patients. However, a second arthroscopic surgical procedure was necessary in 12 patients (12.4%) because of infection recurrence. No significant differences were found between groups except in the volume of irrigation (P < .001). CONCLUSIONS Most patients with septic arthritis (87.6%) of native shoulders were effectively treated with a single arthroscopic irrigation and débridement. The amount of irrigation may be the most important factor for preventing the need for additional surgical management.
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Affiliation(s)
- Yong-Bum Joo
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Woo-Yong Lee
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyung Cheon Kim
- Department of Orthopedic Surgery, Shoulder Center, TanTan Hospital, Daejeon, Republic of Korea
| | - Yun-Ki Kim
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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Kwon JE, Park JS, Park HB, Nam KP, Seo HJ, Kim W, Lee YH, Jeon YD, Oh JH. Arthroscopic Treatment of Septic Arthritis of the Shoulder: Technical Pearls to Reduce the Rate of Reoperation. Clin Shoulder Elb 2020; 23:3-10. [PMID: 33330227 PMCID: PMC7714320 DOI: 10.5397/cise.2019.00402] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 01/19/2020] [Accepted: 01/24/2020] [Indexed: 11/25/2022] Open
Abstract
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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Affiliation(s)
- Ji Eun Kwon
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Ji Soon Park
- Department of Orthopedic Surgery, Healthpoint Hospital, Abu Dhabi, UAE
| | - Hae Bong Park
- Department of Orthopedic Surgery, Human Bone Orthopedic Clinic, Incheon, Korea
| | - Kyung Pyo Nam
- Department of Orthopedic Surgery, Yeson Hospital, Bucheon, Korea
| | - Hyuk Jun Seo
- Department of Orthopedic Surgery, Daegu Chamtntn Hospital, Daegu, Korea
| | - Woo Kim
- Department of Orthopedic Surgery, Seoulkiwoonchan Orthopedic Clinic, Seoul, Korea
| | - Ye Hyun Lee
- Department of Orthopedic Surgery, National Police Hospital, Seoul, Korea
| | - Young Dae Jeon
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Joo Han Oh
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Stake S, Scully R, Swenson S, Lee D, Lee R, Sparks A, Pandarinath R. Repeat irrigation & debridement for patients with acute septic knee arthritis: Incidence and risk factors. J Clin Orthop Trauma 2020; 11:S177-S183. [PMID: 31992942 PMCID: PMC6978190 DOI: 10.1016/j.jcot.2019.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 12/02/2019] [Accepted: 12/07/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Septic knee arthritis is considered an orthopedic emergency due to its significant morbidity and potential to be life-threatening. One important outcome in treatment of septic knee arthritis is whether return to the operating room for repeat irrigation and debridement is required. This complication presents extra burden to the patient, as well as to the health care system. This study aims to first isolate the incidence of repeat irrigation and debridement at the authors' home institution and then define risk factors for repeat washout for septic arthritis of the knee. METHODS Records from all patients at a single academic institution with acute septic knee arthritis who had arthroscopic or open I&D of the knee joint from January 2005-December 2015 were collected retrospectively. Patients were initially identified on the basis of diagnosis coding in the institution's medical information system. Following collection/screening based on strict inclusion/exclusion criteria, a cohort of 63 patients was ultimately included. 18 patients were assigned to a "repeat washout" (RW) cohort and 45 patients were assigned to a "no repeat washout" (NRW) cohort. Univariate analyses and multivariable regression models were performed between the two washout cohorts to identify variables associated with repeat washout. RESULTS Patients requiring a repeat washout (RW) had a statistically significant association with African American/Hispanic race, higher BUN levels, higher serum white blood cell (WBC) count on admission, concurrent infection, and isolated bacteremia when compared to those patients who did not require a repeat washout (NRW) (all respective P < 0.05). Multivariable regression analysis demonstrated concurrent infection and higher synovium WBC count to increase the risk for another repeat washout. Patients who had a concurrent infection were shown to have nearly 12-fold higher odds of needing a repeat washout than those without a concurrent infection (95% CI:2.40-56.88; P = 0.0023). For every 1000 unit increase in synovium WBC count, the odds of needing a repeat washout increased by 1% in patients with concurrent infection (95% CI:1-2%; P = 0.0168). CONCLUSION This study retrospectively isolated risk factors associated with repeat surgical lavage. In the multivariable regression analysis, both concurrent infection and increased synovial WBC count were significantly associated with the need for repeat knee I&D. This finding is significant, as it may signify a potential for increased infectious resilience for acute septic arthritis of the knee secondary to seeding from systemic infection, thus requiring multiple I&Ds to meet resolution. This finding may carry clinical significance in the early stages of patient counseling regarding hospital course and prognosis. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Seth Stake
- The George Washington University Hospital Department of Orthopaedic Surgery, 2300 M St NW, Washington, DC, 20037, USA
| | - Ryan Scully
- The George Washington University Hospital Department of Orthopaedic Surgery, 2300 M St NW, Washington, DC, 20037, USA
| | - Samuel Swenson
- The George Washington University Hospital Department of Orthopaedic Surgery, 2300 M St NW, Washington, DC, 20037, USA
| | - Danny Lee
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Ryan Lee
- The George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Andrew Sparks
- The George Washington University Hospital Department of Orthopaedic Surgery, 2300 M St NW, Washington, DC, 20037, USA
| | - Rajeev Pandarinath
- The George Washington University Hospital Department of Orthopaedic Surgery, 2300 M St NW, Washington, DC, 20037, USA
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Saito T, Noda T, Kondo H, Demiya K, Nezu S, Yokoo S, Matsuhashi M, Uehara T, Shimamura Y, Kodama M, Ozaki T. The Masquelet technique for septic arthritis of the small joint in the hands: Case reports. Trauma Case Rep 2019; 25:100268. [PMID: 31890833 PMCID: PMC6926348 DOI: 10.1016/j.tcr.2019.100268] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2019] [Indexed: 12/26/2022] Open
Abstract
Septic arthritis in distal interphalangeal (DIP) joints sometimes occurs in association with mucous cysts or after the surgical treatment of mallet fingers. Recently, several studies have demonstrated the effectiveness of the Masquelet technique in the treatment of bone defects caused by trauma or infection. However, only few studies have reported the use of this technique for septic arthritis in small joints of the hand, and its effectiveness in treating septic arthritis in DIP joints remains unclear. We report the clinical and radiological outcomes of three patients who were treated with the Masquelet technique for septic arthritis in DIP joints. One patient had uncontrolled diabetes and another had rheumatoid arthritis treated with methotrexate and prednisolone. The first surgical stage involved thorough debridement of the infection site, including the middle and distal phalanx. We placed an external fixator from the middle to the distal phalanx and then packed the cavity of the DIP joint with antibiotic cement bead of polymethylmethacrylate (40 g) including 2 g of vancomycin and 200 mg of minocycline. At 4-6 weeks after the first surgical stage, the infection had cleared, and the second surgical stage was performed. The external fixator and cement bead were carefully removed while carefully preserving the surrounding osteo-induced membrane. The membrane was smooth and nonadherent to the cement block. In the second surgical stage, an autogenous bone graft was harvested from the iliac bone and inserted into the joint space, within the membrane. The bone graft, distal phalanx, and middle phalanx were fixed with Kirschner wires and/or a soft wire. Despite the high risk of infection, bone union was achieved in all patients without recurrence of infection. Although the Masquelet technique requires two surgeries, it can lead to favorable clinical and radiological outcomes for infected small joints of the hand.
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Affiliation(s)
- Taichi Saito
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Tomoyuki Noda
- Department of Musculoskeletal Traumatology, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Hiroya Kondo
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Koji Demiya
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Satoshi Nezu
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Suguru Yokoo
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Minami Matsuhashi
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Takenori Uehara
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | - Yasunori Shimamura
- Department of Sports Medicine, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
| | | | - Toshifumi Ozaki
- Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Density and Pharmaceutical Sciences, Okayama, Japan
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Johnson DJ, Butler BA, Hartwell MJ, Fernandez CE, Nicolay RW, Selley RS, Terry MA, Tjong VK. Arthroscopy versus arthrotomy for the treatment of septic knee arthritis. J Orthop 2019; 19:46-49. [PMID: 32021035 DOI: 10.1016/j.jor.2019.11.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/12/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022] Open
Abstract
Purpose To compare complications following arthroscopy and arthrotomy for treatment of septic knee arthritis. Methods Patients undergoing arthroscopy and arthrotomy for a diagnosis of septic knee arthritis were identified in National Surgical Quality Improvement Program and placed in a multivariate analysis to determine if type of surgery contributed to postoperative complications. Results Knee arthrotomy was associated with an increased risk for increased operative time [Parameter estimate 4.555 (95% CI:3.023-6.085); p < 0.0001], minor morbid events [OR 2.064 (95% CI: 1.447-2.943); p < 0.0001], and any morbidity [OR 2.285 (95% CI:1.527-3.419); p < 0.0001]. Conclusions Knee arthrotomy was associated with a higher risk of complications.
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Affiliation(s)
- Daniel J Johnson
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
| | - Bennet A Butler
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
| | - Matthew J Hartwell
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
| | - Claire E Fernandez
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
| | - Richard W Nicolay
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
| | - Ryan S Selley
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
| | - Michael A Terry
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
| | - Vehniah K Tjong
- Northwestern University Feinberg School of Medicine, Department of Orthopedic Surgery, USA
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Affiliation(s)
- Zachary C Lum
- Adult Reconstruction, Department of Orthopaedics, University of California-Davis Medical Center, Sacramento, California
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Kao FC, Hsu YC, Liu PH, Tu YK, Jou IM. High 2-year mortality and recurrent infection rates after surgical treatment for primary septic arthritis of the hip in adult patients: An observational study. Medicine (Baltimore) 2019; 98:e16765. [PMID: 31393395 PMCID: PMC6708796 DOI: 10.1097/md.0000000000016765] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Primary septic arthritis of the hip is rare and potentially devastating in adults. Its optimal surgical treatment and clinical outcomes remain unclear.In this retrospective cohort study, we investigated mortality and reinfection rates after surgery of patients with septic hip arthritis. We reviewed patients treated for primary septic hip joints from October 2005 to December 2016. A total of 51 adult patients were identified, and 38 among them had destructive hip joints. A poor postoperative outcome was defined as mortality or recurrent infection within 2 years of surgery.After surgery, 7 (13.7%) patients died within 1 year and 5 (9.8%) patients developed a recurrent hip infection within 2 years. Therefore, poor outcomes occurred in 22% (n = 11) of the study cohort. Among the 38 patients with a destructive hip joint, 7 (18.4%) died within 1 year after surgery and 4 (10.5%) developed a recurrent hip infection within 2 years of surgery. Correlative infections other than infected hip joint and liver cirrhosis were identified as risk factors for poor outcomes.In conclusion, clinical physicians treating adult primary septic hip joints should be cognizant of the high failure rate of surgical treatment. In addition, the high mortality rate should be considered during the discussion of surgical treatment with these patients and their families.
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Affiliation(s)
- Feng-Chen Kao
- Department of Orthopedics, E-Da Dachang Hospital
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung
| | - Yao-Chun Hsu
- School of Medicine, Big Data Research Center, Fu-Jen Catholic University
- Division of Gastroenterology, Fu-Jen Catholic University Hospital, New Taipei
- Graduate Institute of Clinical Medicine, China Medical University, Taichung
- Division of Gastroenterology and Hepatology, E-Da Hospital
| | - Pao-Hsin Liu
- Department of Biomedical Engineering, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Yuan-Kun Tu
- Department of Orthopedics, E-Da Dachang Hospital
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung
| | - I-Ming Jou
- Department of Orthopedics, E-Da Dachang Hospital
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung
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Abstract
INTRODUCTION Septic arthritis of the hip (SAH) is a common condition encountered by pediatric orthopaedic surgeons and is treated with arthrotomy and irrigation. Depending on the response to initial treatment, some patients require surgical treatment beyond the index procedure. The purpose of this study was to investigate risk factors for repeat surgical intervention after initial arthrotomy for presumed SAH. METHODS A multicenter retrospective review of all children who underwent surgical arthrotomy for presumed SAH over a ten-year period was conducted. Variables queried included demographics, clinical presentation, laboratory parameters, imaging, infecting organism, presence of osteomyelitis, and surgical interventions performed. Logistic regression was used to predict the risk of a second procedure. Chi-square was used to compare patients who required further surgery and those who did not. RESULTS One hundred and thirty-eight patients (139 hips) qualified for inclusion. The average age at initial surgery was 6.1 years (range, zero to 17 years), and 57% of the patients were male. Concomitant osteomyelitis was diagnosed in 55 cases (40%). An infecting organism was identified from 70 (50%) index intraoperative cultures, with Staphylococcus aureus infections (methicillin-resistant Staphylococcus aureus [MRSA], 27; methicillin-sensitive Staphylococcus aureus, 25) being the most frequent. Fifty-six patients (41%) underwent subsequent surgical intervention, at an average of 5.5 days (range, 2 to 95) from the index procedure. Independent risk factors for repeat surgical procedures included presenting C-reactive protein >10 mg/dL (P = 0.002) and presenting erythrocyte sedimentation rate >40 (P = 0.011). The odds of repeat surgical intervention were significantly increased by the presence of concomitant osteomyelitis (odds ratio, 3.4; P = 0.001) and positive index intraoperative cultures for MRSA (odds ratio, 1.19; P = 0.001). Preoperative MRI before the index procedure was not universal (73/138; 53%), and acquisition of preoperative MRI was not associated with secondary surgical intervention (P = 0.389). DISCUSSION Forty-one percent of children in this multicenter cohort underwent at least one repeat surgical procedure after the index arthrotomy for management of presumed SAH. Risk factors for return to the operating room include elevated initial erythrocyte sedimentation rate and C-reactive protein, infection with MRSA, and presence of osteomyelitis. LEVEL OF EVIDENCE Level 3, case-cohort series. Type of evidence, therapeutic.
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