Skip to main content

Advertisement

SpringerLink
Log in

Re-operation rates of arthroscopic management versus arthrotomy in treatment of septic arthritis of native shoulder joint in adults. A systematic review and meta-analysis

  • General Review
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Aims

Previous studies have reported concern regarding high reoperation rates when septic arthritis of the native shoulder is treated arthroscopically, compared to open arthrotomy. We aimed to compare re-operation rate between the two strategies.

Patients and methods

The review was registered prospectively at PROSPERO, (CRD42021226518). We searched common databases and references lists (8 February 2021). The inclusion criteria included interventional or observational studies of adult patients with a confirmed diagnosis of native shoulder joint septic arthritis and had either arthroscopy or arthrotomy. The exclusion criteria included patients with periprosthetic or post-surgical infections, patients who had atypical infections, and studies that did not report re-operation rate. Cochrane Collaboration’s tool for assessing risk of bias (ROBINS-I) was used.

Results

Nine studies (retrospective cohort studies) were included that involved 5,643 patients (5,645 shoulders). Mean age ranged from 55.6 to 75.5 years, and follow-up time ranged from 1–41 months. Mean duration of symptoms prior to presentation ranged from 8.3–23.3 days. Metanalysis observed a higher re-operation rate for reinfection at any time point following initial arthroscopy in comparison to arthrotomy, odds ratio 2.61 (95% confidence interval 1.04, 6.56). There was marked heterogeneity (I2 = 78.8%) among studies including surgical techniques and missing data.

Conclusion

This metanalysis observed a higher reoperation rate in arthroscopy in comparison to arthrotomy for the treatment of native shoulder septic arthritis in adults. The quality of the included evidence is low and the heterogeneity among included studies is marked. Higher quality evidence is still needed that address limitations of previous studies.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Data availability

The datasets used or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M (1999) Clinical features and outcome of septic arthritis in a single UK health district 1982–1991. Ann Rheum Dis 58(4):214–219

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Clerc O, Prod’hom G, Greub G, Zanetti G, Senn L (2011) Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy. J Antimicrob Chemother 66(5):1168–1173

    Article  CAS  PubMed  Google Scholar 

  3. Assunção JH, Noffs GG, Malavolta EA, Gracitelli MEC, Lima ALM, Ferreira Neto AA (2018) Septic arthritis of the shoulder and elbow: one decade of epidemiological analysis at a tertiary referral hospital. Rev Bras Ortop 53(6):707–713

    Article  PubMed  PubMed Central  Google Scholar 

  4. Mehta P, Schnall SB, Zalavras CG (2006) Septic arthritis of the shoulder, elbow, and wrist. Clin Orthop Relat Res 451:42–45

    Article  PubMed  Google Scholar 

  5. Leslie BM, Harris JM, Driscoll D (1989) Septic arthritis of the shoulder in adults. The J Bone Joint Surg Am Vol 71(10):1516–22

    Article  CAS  Google Scholar 

  6. Jiang JJ, Piponov HI, Mass DP, Angeles JG, Shi LL (2017) Septic arthritis of the shoulder: a comparison of treatment methods. J Am Acad Orthop Surg 25(8):e175–e184

    Article  PubMed  Google Scholar 

  7. Böhler C, Dragana M, Puchner S, Windhager R, Holinka J (2016) Treatment of septic arthritis of the knee: a comparison between arthroscopy and arthrotomy. Knee Surg Sports Traumatol Arthrosc 24(10):3147–3154

    Article  PubMed  Google Scholar 

  8. Abdel MP, Perry KI, Morrey ME, Steinmann SP, Sperling JW, Cass JR (2013) Arthroscopic management of native shoulder septic arthritis. J Shoulder Elbow Surg 22(3):418–21

    Article  PubMed  Google Scholar 

  9. VispoSeara JL, Barthel T, Schmitz H, Eulert J (2002) Arthroscopic treatment of septic joints: prognostic factors. Arch Orthop Trauma Surg 122(4):204–11

    Article  CAS  Google Scholar 

  10. Bohler C, Pock A, Waldstein W, Staats K, Puchner SE, Holinka J et al (2017) Surgical treatment of shoulder infections: a comparison between arthroscopy and arthrotomy. J Shoulder Elbow Surg 26(11):1915–21

    Article  PubMed  Google Scholar 

  11. Kim S-J, Choi Y-R, Lee W, Jung W-S, Chun Y-M (2018) Arthroscopic debridement for septic arthritis of the shoulder joint: post-infectious arthritis is an inevitable consequence? Arch Orthop Trauma Surg 138(9):1257–63

    Article  PubMed  Google Scholar 

  12. Lee DK, Rhee S-M, Jeong HY, Ro K, Jeon YS, Rhee YG (2019) Treatment of acute shoulder infection: can osseous lesion be a rudder in guideline for determining the method of debridement? J Shoulder Elbow Surg 28(12):2317–25

    Article  PubMed  Google Scholar 

  13. Jeon I-H, Choi C-H, Seo J-S, Seo K-J, Ko S-H, Park J-Y (2006) Arthroscopic management of septic arthritis of the shoulder joint. The J Bone Joint Surg Am Vol 88(8):1802–6

    Google Scholar 

  14. Jung HJ, Song JH, Kekatpure AL, Adikrishna A, Hong HP, Lee WJ et al (2016) The use of continuous negative pressure after open debridement for septic arthritis of the shoulder. The Bone Joint J 98(5):660–5

    Article  PubMed  Google Scholar 

  15. Moher D, Shamseer L, Clarke M, Ghersi D, Liberati A, Petticrew M et al (2015) Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev 4:1

    Article  PubMed  PubMed Central  Google Scholar 

  16. Gramlich Y, Klug A, Walter G, Kremer M, Hoffmann R, Kemmerer M (2020) Septic arthritis of native shoulder and knee joint: what are the differences in bacterial spectrum, treatment, and outcome? Surg Infect 21(4):391–7

    Article  Google Scholar 

  17. Kirchhoff C, Braunstein V, Buhmann Kirchhoff S, Oedekoven T, Mutschler W, Biberthaler P (2009) Stage-dependant management of septic arthritis of the shoulder in adults. Int orthop 33(4):1015–24

    Article  CAS  PubMed  Google Scholar 

  18. Stutz G, Kuster MS, Kleinstuck F, Gachter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8(5):270–274

    Article  CAS  PubMed  Google Scholar 

  19. Amstutz HC, Sew Hoy AL, Clarke IC (1981) UCLA anatomic total shoulder arthroplasty. Clin Orthop Relat Res 155:7–20

    Article  Google Scholar 

  20. Conboy VB, Morris RW, Kiss J, Carr AJ (1996) An evaluation of the Constant-Murley shoulder assessment. J Bone Joint Surg Br 78(2):229–232

    Article  CAS  PubMed  Google Scholar 

  21. Sterne JA, Hernán MA, Reeves BC, Savović J, Berkman ND, Viswanathan M et al (2016) ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 355:i4919

    Article  PubMed  PubMed Central  Google Scholar 

  22. Guyatt G, Oxman AD, Akl EA, Kunz R, Vist G, Brozek J et al (2011) GRADE guidelines: 1. introduction-GRADE evidence profiles and summary of findings tables. J Clin Epidemiol. 64(4):383–94

    Article  PubMed  Google Scholar 

  23. DerSimonian R, Laird N (1986) Meta-analysis in clinical trials. Control Clin Trials 7(3):177–188

    Article  CAS  PubMed  Google Scholar 

  24. Higgins JP, Thompson SG, Deeks JJ, Altman DG (2003) Measuring inconsistency in meta-analyses. BMJ 327(7414):557–560

    Article  PubMed  PubMed Central  Google Scholar 

  25. Egger M, Davey Smith G, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. BMJ 315(7109):629–634

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Khazi ZM, Cates WT, Shamrock AG, An Q, Duchman KR, Westermann RW et al (2020) Arthroscopic debridement has similar 30-day complications compared with open arthrotomy for the treatment of native shoulder septic arthritis: a population-based study. J Shoulder Elbow Surg 29(6):1121–6

    Article  PubMed  Google Scholar 

  27. Bovonratwet P, Fu MC, Pathak N, Ondeck NT, Bohl DD, Nho SJ et al (2019) Surgical treatment of septic shoulders: a comparison between arthrotomy and arthroscopy. Arthrosc J Arthrosc Rel Surg 35(7):1984–1991

    Article  Google Scholar 

  28. Rhee YG, Cho NS, Kim BH, Ha JH (2008) Injection-induced pyogenic arthritis of the shoulder joint. J Shoulder Elbow Surg 17(1):63–7

    Article  PubMed  Google Scholar 

  29. Duncan SF, Sperling JW (2008) Treatment of primary isolated shoulder sepsis in the adult patient. Clin Orthop Relat Res 466(6):1392–1396

    Article  PubMed  PubMed Central  Google Scholar 

  30. Cho C-H, Oh G-M (2016) Prognostic factors affecting the clinical outcome of septic arthritis of the shoulder. The J Hand Surg Asian Pac Vol 21(3):339–44

    Article  PubMed  Google Scholar 

  31. Malavolta EA, Yamamoto GJ, Bussius DT, Assunção JH, Andrade-Silva FB, Gracitelli MEC et al (2021) Establishing minimal clinically important difference for the UCLA and ASES scores after rotator cuff repair. Orthop Traumatol Surg Res. 108(2):102894

    Article  PubMed  Google Scholar 

  32. Holmgren T, Oberg B, Adolfsson L, BjörnssonHallgren H, Johansson K (2014) Minimal important changes in the Constant-Murley score in patients with subacromial pain. J Shoulder Elbow Surg 23(8):1083–1090

    Article  PubMed  Google Scholar 

  33. Memon M, Kay J, Ginsberg L, de Sa D, Simunovic N, Samuelsson K et al (2018) Arthroscopic management of septic arthritis of the native shoulder: a systematic review. Arthrosc J Arthrosc relat Surg 34(2):625–46.e1

    Article  Google Scholar 

  34. Acosta-Olivo C, Vilchez-Cavazos F, Blázquez-Saldaña J, Villarreal-Villarreal G, Peña-Martínez V, Simental-Mendía M (2021) Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis. Int Orthop 45(8):1947–1959

    Article  PubMed  Google Scholar 

  35. Kwon JE, Park JS, Park HB, Nam KP, Seo HJ, Kim W et al (2020) Arthroscopic treatment of septic arthritis of the shoulder: technical pearls to reduce the rate of reoperation. Clin shoulder and elbow 23(1):3–10

    Article  Google Scholar 

  36. Joo Y-B, Lee W-Y, Shin HD, Kim KC, Kim Y-K (2020) 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 29(3):497–501

    Article  PubMed  Google Scholar 

  37. Abdou MA, Jo A, Choi I-S, Iim C-J, Park H-K, Oh H-K et al (2019) Shoulder joint infections with negative culture results: clinical characteristics and treatment outcomes. Biomed Res Int 2019:3756939

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom

    Amir Abdelmalek, Samuel Haines, Baha John Tadros, Jonathan T. Evans & Andrew Judge

Authors
  1. Amir Abdelmalek
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Samuel Haines
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Baha John Tadros
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan T. Evans
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Andrew Judge
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AA contributed toConceptualisation, literature search, data collection, data analysis and writing–original draft preparation––reviewing and editing. SH contributed to Contribution: data collection, data review, analysis and writing draft—reviewing and editing. BJT contributed to data collection, data review, analysis and writing draft- reviewing and editing. JTE contributed to Supervision and writing draft- reviewing and editing. AJ contributed to Supervision and writing draft- reviewing and editing.

Corresponding author

Correspondence to Amir Abdelmalek.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abdelmalek, A., Haines, S., Tadros, B.J. et al. Re-operation rates of arthroscopic management versus arthrotomy in treatment of septic arthritis of native shoulder joint in adults. A systematic review and meta-analysis. Eur J Orthop Surg Traumatol 33, 2717–2727 (2023). https://doi.org/10.1007/s00590-023-03495-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-023-03495-0

Keywords

Search

Navigation