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Osteomyelitis on MR imaging as a key predictor of recurrent septic arthritis of the shoulder

  • Musculoskeletal
  • Published:
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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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Abbreviations

CI:

Confidence interval

CRP:

C-reactive protein

FSE:

Fast spin-echo

SAS:

Septic arthritis of the shoulder

WBC:

White blood cell

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea

    Suk-Woong Kang & Won Chul Shin

  2. Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, 50612, Gyeongsananam-do, Korea

    Chankue Park, Hee Seok Jeong & Ki Seok Choo

  3. Department of Preventive and Occupational & Environmental Medicine, Medical College, Pusan National University, Yangsan, Korea

    Min Hyeok Choi

  4. Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan, Korea

    Min Hyeok Choi

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  1. Suk-Woong Kang
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  2. Chankue Park
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  3. Min Hyeok Choi
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  4. Won Chul Shin
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  5. Hee Seok Jeong
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Corresponding author

Correspondence to Chankue Park.

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Guarantor

The scientific guarantor of this publication is Dr. Chankue Park.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors (Min Hyeok Choi) has significant statistical expertise.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• retrospective

• observational

• performed at one institution

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Kang, SW., Park, C., Choi, M.H. et al. Osteomyelitis on MR imaging as a key predictor of recurrent septic arthritis of the shoulder. Eur Radiol 32, 1419–1428 (2022). https://doi.org/10.1007/s00330-021-08238-5

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  • DOI: https://doi.org/10.1007/s00330-021-08238-5

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