Antibiotics, Drainage Help Control Postarthroscopic Septic Arthritis

TORONTO — Most cases of septic arthritis resulting from arthroscopic joint surgery can be controlled with conservative treatment comprising prolonged IV antibiotics and surgical drainage, as long as there is no bone involvement and the affected joint has not been compromised, Dr. Carla Vizzotti said at the annual meeting of the Infectious Diseases Society of America.

Although postarthroscopic septic arthritis (PASA) is an infrequent condition, it can result in significant morbidity if not properly treated and can interfere with patients' recovery, Dr. Vizzotti said in a poster presentation.

Because medical and surgical therapies for the condition are not standardized, Dr. Vizzotti and colleagues at the Fundación Centro de Estudios Infectológicos in Buenos Aires, conducted a retrospective investigation to identify optimal management strategies.

The investigators reviewed the records of 61 patients treated for PASA between November 1991 and November 2005. Patients were included in the investigation if, following a diagnostic or operative arthroscopic procedure, they developed at least one of the clinical signs of arthritis—increased pain, swelling, and warmth—in the affected joint, and/or developed a fever and had a positive culture or grossly or macroscopically purulent synovial fluid.

The mean age of the patients was 37.2 years and the mean follow-up period was 32.5 months.

Among the 61 patients, there were a total of 63 infections, including 58 in the knee, 4 in the shoulder, and 1 in the ankle. Of the 63 infections, 41 occurred in patients who underwent arthroscopic ligament repair that included a graft or implant insertion.

In terms of clinical presentation, fever and pain were each noted in 41 cases; red skin, swelling, and/or warmth were present in 53 cases; fistula and purulent discharges were each noted in 9 cases; functional impotence occurred in 10 cases; and an elevated erythrocyte sedimentation rate (greater than 50 mm/hour) was reported in 7 cases.

Microbiologic data were available for all but two of the infections.

Gram-positive cocci were implicated in 39 of the infections, gram-negative bacilli were identified in 9 of them, and negative cultures were noted in 13, Dr. Vizzotti reported. All of the patients received antibiotic therapy—primarily β-lactams—for a mean of 9.2 weeks.

Surgical drainage was used in 48 of the 63 infections, including arthroscopic irrigation and lavage of the joint in 38 cases, lavage of the joint via arthrotomy in 2 cases, needle aspiration in 6 cases, and combined needle aspiration and arthroscopic irrigation in 2 cases.

Of the study population, only four patients required removal of the grafts or implants that were used to repair the ligaments because of joint instability and/or bone involvement, Dr. Vizzotti said.

Treatment resulted in cure or significant improvement in 97% of the patients.

Three patients experienced complications of infection, including osteomyelitis in two patients and toxic shock syndrome in one.

The findings of the study suggest that most patients with postarthroscopic septic arthritis can be successfully treated with a combination of antibiotics and joint irrigation and lavage, Dr. Vizzotti stated.

Additionally, “as long as the joint is stable and functioning, and if there is no bone involvement, it is uncommon for a patient to require graft or implant removal,” she said.

Dr. Vizzotti reported having no financial disclosures relative to her presentation.

TORONTO — Most cases of septic arthritis resulting from arthroscopic joint surgery can be controlled with conservative treatment comprising prolonged IV antibiotics and surgical drainage, as long as there is no bone involvement and the affected joint has not been compromised, Dr. Carla Vizzotti said at the annual meeting of the Infectious Diseases Society of America.

Although postarthroscopic septic arthritis (PASA) is an infrequent condition, it can result in significant morbidity if not properly treated and can interfere with patients' recovery, Dr. Vizzotti said in a poster presentation.

Because medical and surgical therapies for the condition are not standardized, Dr. Vizzotti and colleagues at the Fundación Centro de Estudios Infectológicos in Buenos Aires, conducted a retrospective investigation to identify optimal management strategies.

The investigators reviewed the records of 61 patients treated for PASA between November 1991 and November 2005. Patients were included in the investigation if, following a diagnostic or operative arthroscopic procedure, they developed at least one of the clinical signs of arthritis—increased pain, swelling, and warmth—in the affected joint, and/or developed a fever and had a positive culture or grossly or macroscopically purulent synovial fluid.

The mean age of the patients was 37.2 years and the mean follow-up period was 32.5 months.

Among the 61 patients, there were a total of 63 infections, including 58 in the knee, 4 in the shoulder, and 1 in the ankle. Of the 63 infections, 41 occurred in patients who underwent arthroscopic ligament repair that included a graft or implant insertion.

In terms of clinical presentation, fever and pain were each noted in 41 cases; red skin, swelling, and/or warmth were present in 53 cases; fistula and purulent discharges were each noted in 9 cases; functional impotence occurred in 10 cases; and an elevated erythrocyte sedimentation rate (greater than 50 mm/hour) was reported in 7 cases.

Microbiologic data were available for all but two of the infections.

Gram-positive cocci were implicated in 39 of the infections, gram-negative bacilli were identified in 9 of them, and negative cultures were noted in 13, Dr. Vizzotti reported. All of the patients received antibiotic therapy—primarily β-lactams—for a mean of 9.2 weeks.

Surgical drainage was used in 48 of the 63 infections, including arthroscopic irrigation and lavage of the joint in 38 cases, lavage of the joint via arthrotomy in 2 cases, needle aspiration in 6 cases, and combined needle aspiration and arthroscopic irrigation in 2 cases.

Of the study population, only four patients required removal of the grafts or implants that were used to repair the ligaments because of joint instability and/or bone involvement, Dr. Vizzotti said.

Treatment resulted in cure or significant improvement in 97% of the patients.

Three patients experienced complications of infection, including osteomyelitis in two patients and toxic shock syndrome in one.

The findings of the study suggest that most patients with postarthroscopic septic arthritis can be successfully treated with a combination of antibiotics and joint irrigation and lavage, Dr. Vizzotti stated.

Additionally, “as long as the joint is stable and functioning, and if there is no bone involvement, it is uncommon for a patient to require graft or implant removal,” she said.

Dr. Vizzotti reported having no financial disclosures relative to her presentation.

TORONTO — Most cases of septic arthritis resulting from arthroscopic joint surgery can be controlled with conservative treatment comprising prolonged IV antibiotics and surgical drainage, as long as there is no bone involvement and the affected joint has not been compromised, Dr. Carla Vizzotti said at the annual meeting of the Infectious Diseases Society of America.

Although postarthroscopic septic arthritis (PASA) is an infrequent condition, it can result in significant morbidity if not properly treated and can interfere with patients' recovery, Dr. Vizzotti said in a poster presentation.

Because medical and surgical therapies for the condition are not standardized, Dr. Vizzotti and colleagues at the Fundación Centro de Estudios Infectológicos in Buenos Aires, conducted a retrospective investigation to identify optimal management strategies.

The investigators reviewed the records of 61 patients treated for PASA between November 1991 and November 2005. Patients were included in the investigation if, following a diagnostic or operative arthroscopic procedure, they developed at least one of the clinical signs of arthritis—increased pain, swelling, and warmth—in the affected joint, and/or developed a fever and had a positive culture or grossly or macroscopically purulent synovial fluid.

The mean age of the patients was 37.2 years and the mean follow-up period was 32.5 months.

Among the 61 patients, there were a total of 63 infections, including 58 in the knee, 4 in the shoulder, and 1 in the ankle. Of the 63 infections, 41 occurred in patients who underwent arthroscopic ligament repair that included a graft or implant insertion.

In terms of clinical presentation, fever and pain were each noted in 41 cases; red skin, swelling, and/or warmth were present in 53 cases; fistula and purulent discharges were each noted in 9 cases; functional impotence occurred in 10 cases; and an elevated erythrocyte sedimentation rate (greater than 50 mm/hour) was reported in 7 cases.

Microbiologic data were available for all but two of the infections.

Gram-positive cocci were implicated in 39 of the infections, gram-negative bacilli were identified in 9 of them, and negative cultures were noted in 13, Dr. Vizzotti reported. All of the patients received antibiotic therapy—primarily β-lactams—for a mean of 9.2 weeks.

Surgical drainage was used in 48 of the 63 infections, including arthroscopic irrigation and lavage of the joint in 38 cases, lavage of the joint via arthrotomy in 2 cases, needle aspiration in 6 cases, and combined needle aspiration and arthroscopic irrigation in 2 cases.

Of the study population, only four patients required removal of the grafts or implants that were used to repair the ligaments because of joint instability and/or bone involvement, Dr. Vizzotti said.

Treatment resulted in cure or significant improvement in 97% of the patients.

Three patients experienced complications of infection, including osteomyelitis in two patients and toxic shock syndrome in one.

The findings of the study suggest that most patients with postarthroscopic septic arthritis can be successfully treated with a combination of antibiotics and joint irrigation and lavage, Dr. Vizzotti stated.

Additionally, “as long as the joint is stable and functioning, and if there is no bone involvement, it is uncommon for a patient to require graft or implant removal,” she said.

Dr. Vizzotti reported having no financial disclosures relative to her presentation.