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

International Orthopaedics volume 36, pages 1727–1731 (2012)Cite this article

Abstract

Purpose

Septic arthritis is a life-threatening emergency with high mortality of up to 11 %. We investigated if delay of arthroscopic lavage of infected major joints would have a bearing on the mortality and morbidity such as admission to an intensive care unit (ICU).

Methods

We retrospectively reviewed patients presenting with septic arthritis to two regional hospitals over a period of seven years from 1 January 2005 to 31 December 2011. We divided our sample of 82 patients into four groups based on the time delay between clinical diagnosis and arthroscopic lavage ranging from less than six hours to more than 24 hours.

Results

We determined that 35.4 % of patients had prosthetic joints. Knee joints were predominantly involved (74.4 %). Staphylococcus aureus was the most commonly isolated pathogen (41.5 %). There were ten (12.2 %) deaths and the same number of admissions to an ICU. Our study revealed there was no statistical significance between the time delay and mortality (P = 0.25) or ICU admission (P = 0.74) or the number of washouts (P = 0.08) in all four groups.

Conclusions

Up to 48 hours delayed arthroscopic lavage for septic arthritis does not increase the risk of mortality. Further prospective large sample studies are recommended to investigate this and the risk of long-term morbidity.

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References

  1. Tarkowski A (2006) Infection and musculoskeletal conditions: infectious arthritis. Best Pract Res Clin Rheumatol 20:1029–1044

    PubMed  Article  CAS  Google Scholar 

  2. Goldenberg DL, Cohen AS (1976) Acute infectious arthritis. A review of patients with nongonococcal joint infections (with emphasis on therapy and prognosis). Am J Med 60(3):369–377

    PubMed  Article  CAS  Google Scholar 

  3. Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 56:470–475

    PubMed  Article  CAS  Google Scholar 

  4. Le Dantec L, Maury F, Flipo RM, Laskri S, Cortet B, Duquesnoy B, Delcambre B (1996) Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases. Rev Rhum Engl Ed 63:103–110

    PubMed  Google Scholar 

  5. Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117:423–428

    PubMed  Article  CAS  Google Scholar 

  6. Kaandorp CJE, van Schaardenburg D, Krijnen P, Habbema JDF, van de Laae MAFJ (1995) Risk factors for septic arthritis in patients with joint disease. A prospective study. Arthritis Rheum 38:1819–1825

    PubMed  Article  CAS  Google Scholar 

  7. Gupta MN, Sturrock RD, Field M (2001) A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatology (Oxford) 40:24–30

    Article  CAS  Google Scholar 

  8. Sharp JT, Lidsky MD, Duffy J, Duncan MW (1979) Infectious arthritis. Arch Intern Med 139:1125–1130

    PubMed  Article  CAS  Google Scholar 

  9. Meijers KA, Dijkmans BA, Hermans J, van den Broek PJ, Cats A (1987) Non-gonococcal infectious arthritis: a retrospective study. J Infect 14:13–20

    PubMed  Article  CAS  Google Scholar 

  10. Manadan AM, Block J (2004) Daily needle aspiration versus surgical lavage for the treatment of bacterial septic arthritis in adults. Am J Ther 11(5):412–415

    PubMed  Article  Google Scholar 

  11. Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M, Walker D, Coakley G (2007) Management of septic arthritis: a systematic review. Ann Rheum Dis 66:440–445

    PubMed  CAS  Google Scholar 

  12. Wirtz D, Marth M, Miltner O, Schneider U, Zilkens K (2001) Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy. Int Orthop 25(4):239–241

    PubMed  Article  CAS  Google Scholar 

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

    PubMed  Article  CAS  Google Scholar 

  14. Coakley G, Mathews C, Field M, Jones A, Kingsley G, Walker D, Phillips M, Bradish C, McLachlan A, Mohammed R, Weston V, British Society for Rheumatology Standards, Guidelines and Audit Working Group (2006) BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatology (Oxford) 45:1039–1041

    Article  CAS  Google Scholar 

  15. Balabaud L, Gaudias J, Boeri C, Jenny JY, Kehr P (2007) Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc 15:387–392

    PubMed  Article  Google Scholar 

  16. Eyichukwu GO, Onyemaechi NO, Onyegbule EC (2010) Outcome of management of non-gonococcal septic arthritis at National Orthopaedic Hospital, Enugu, Nigeria. Niger J Med 19(1):69–76

    PubMed  CAS  Google Scholar 

  17. Jeon IH, Choi CH, Seo JS, Seo KJ, Ko SH, Park JY (2006) Arthroscopic management of septic arthritis of the shoulder joint. J Bone Joint Surg Am 88(8):1802–1806

    PubMed  Article  Google Scholar 

  18. Vispo Seara JL, Barthel T, Schmitz H, Eulert J (2002) Arthroscopic treatment of septic joints: prognostic factors. Arch Orthop Trauma Surg 122(4):204–211

    PubMed  Article  CAS  Google Scholar 

  19. Klinger HM, Baums MH, Freche S, Nusselt T, Spahn G, Steckel H (2010) Septic arthritis of the shoulder joint: an analysis of management and outcome. Acta Orthop Belg 76(5):598–603

    PubMed  Google Scholar 

  20. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654

    PubMed  Article  CAS  Google Scholar 

  21. Yanmış I, Ozkan H, Koca K, Kılınçoğlu V, Bek D, Tunay S (2011) The relation between the arthroscopic findings and functional outcomes in patients with septic arthritis of the knee joint, treated with arthroscopic debridement and irrigation. Acta Orthop Traumatol Turc 45(2):94–99

    PubMed  Article  Google Scholar 

  22. http://www.drfosterhealth.co.uk/hospital-guide/hospital/nhs/Queens-Medical-Centre-476.aspx. Accessed 4 Apr 2012

  23. http://www.drfosterhealth.co.uk/hospital-guide/hospital/nhs/Royal-Derby-Hospital-511.aspx. Accessed 4 Apr 2012

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Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Affiliations

  1. Nottingham University Hospitals, Nottingham, UK

    Preetham Kodumuri

  2. 7 Fradgley Grove, Uttoxeter, East Staffordshire, ST14 5NT, UK

    Preetham Kodumuri

  3. Royal Derby Hospitals, Derby, UK

    Guido Geutjens

  4. Weston General Hospital, Grange Road, Uphill, Weston-super-Mare, Somerset, BS23 4TQ, UK

    Hui-Ling Kerr

Authors
  1. Preetham Kodumuri
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  2. Guido Geutjens
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  3. Hui-Ling Kerr
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Correspondence to Preetham Kodumuri.

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Kodumuri, P., Geutjens, G. & Kerr, HL. Time delay between diagnosis and arthroscopic lavage in septic arthritis. Does it matter?. International Orthopaedics (SICOT) 36, 1727–1731 (2012). https://doi.org/10.1007/s00264-012-1546-1

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  • DOI: https://doi.org/10.1007/s00264-012-1546-1

Keywords

  • Intensive Care Unit
  • Anterior Cruciate Ligament
  • Synovial Fluid
  • Intensive Care Unit Admission
  • Septic Arthritis