Orthopedics Medical News about Septic Arthritis

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Comparison of arthroscopic and open treatment of septic arthritis of the wrist
Journal of Bone and Joint Surgery, 06/02/09

Sammer DM et al. – Study demonstrates that arthroscopic irrigation and débridement is an effective treatment for patients with isolated septic arthritis of the wrist; these patients had fewer operations and a shorter hospital stay than did patients who had received open treatment. However, these benefits were not seen in patients with multiple sites of infection.

Methods

A comparison of arthroscopic and open techniques in pts with septic arthritis of wrist
Pts initially treated over an 11-year period, with open or arthroscopic irrigation and débridement
Clinical presentation, laboratory and microbiological findings, hospital course, complications, and outcomes were compared between the 2 groups

Results

Between 1997 and 2007, 36 pts with septic arthritis involving a total of 40 wrists were identified
19 wrists (17 pts) were initially treated with open irrigation and débridement, and 21 wrists (19 pts) were initially treated arthroscopically
11 wrists in the open-treatment cohort required repeat irrigation and debridement
8 wrists in the arthroscopy cohort required a repeat procedure
If a repeat irrigation and débridement was required, it was performed in an open fashion in all but 2 cases
No patient treated with arthroscopic irrigation and débridement required a second operation
The pts who went through open method stayed longer in in the hospital
The 90-day perioperative mortality rate in the series was substantial

Exclusive Author Commentary
Douglas M. Sammer, 06/16/09

Although arthroscopy has proven very useful for treating septic arthritis in large joints such as the knee and hip, arthroscopic I&D of the wrist has not been previously evaluated. This study demonstrates potential advantages to arthroscopic I&D of the wrist. However, some questions remain unanswered. For example, does the chronicity of the infection affect which treatment method (open vs. arthroscopic) should be used? A prospective randomized study would provide more useful information about the indications, advantages, and disadvantages of arthroscopic versus open I&D. Because of the relatively low incidence of septic arthritis in the wrist, this would likely require a multi-center collaborative effort.

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