Staging Septic Arthritis Aids Assessment Of Prognosis And Treatment

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Staging Septic Arthritis Aids Assessment Of Prognosis And Treatment

A DGReview of : " Knee: Arthroscopic management of septic arthritis: stages of

infection and

results "

Knee Surgery Sports Traumatology Arthroscopy

01/31/2001

By Mark Greener

Staging the joint infection among patients with septic arthritis aids assessment

of both

prognosis and treatment, report researchers from Switzerland.

Researchers at from Kantonsspital St. Gallen enrolled 76 patients with septic

arthritis that

affected 62 knees, ten shoulders, five ankles and one hip. Patients were treated

using

arthroscopic irrigation, débridement and antibiotics based on bacterial

sensitivity. The authors

stratified patients into three groups depending on the initial joint infection.

Hematogenous dissemination was the most common cause of infection, accounting

for 54

percent of cases. The infection arose after open and arthroscopic operations in

17 and 11

percent of patients, respectively. Intra-articular steroid injections,

diagnostic punctures and

open traumatic injury accounted for 10, 3 and 3 percent of infections,

respectively.

The authors isolated a causative organism from 78 percent of infected joints.

Staphylococcus

aureus was the commonest organism isolated (42 per cent of joints).

Streptococci,

pneumococci and Escherichia coli accounted for 15, 6 and 4 percent of

infections,

respectively. Staphylococcus epidermidis and Borrelia burgdorferi each accounted

for three

percent of the causative organisms, while a variety of organisms accounted for

the other

infections.

One stage I patient required repeated arthroscopic irrigation. This compared to

52 and 75

percent of the stage II and III groups, respectively. Open revision to eradicate

the infection

was performed in one stage II joint and two stage III joints. Two stage III

joints needed

additional surgery after the infection was treated.

Overall, the authors reported that combining arthroscopic irrigation and

systemic antibiotics

cured 91 percent of affected joints. However, 4 percent of joints needed open

revision.

The authors concluded that staging the initial joint infection aids assessment

of prognosis and

treatment in people with septic arthritis. Indeed, the initial stage influences

the number of

arthroscopic procedures as well as treatment effectiveness.