High volume of irrigation may reduce risk of recurrent septic arthritis of the shoulder
Click Here to Manage Email Alerts
Single arthroscopic irrigation and debridement effectively eradicated septic arthritis among most native shoulder joints, with volume of irrigation reported as an important factor to prevent additional surgical management, according to published results.
Researchers categorized 97 patients with septic arthritis of the shoulder who underwent arthroscopic irrigation and debridement based on whether they experienced eradication or recurrence of their septic arthritis. Researchers considered patient and injury parameters to identify risk factors affecting the recurrence of septic arthritis of the shoulder after arthroscopic surgery and compared the presence of potential risk factors between the eradicated and recurred groups.
Results showed 85 of 97 patients (87.6%) had septic arthritis of the shoulder eradicated completely with a single arthroscopic surgical procedure. Researchers found 12 patients underwent a second arthroscopic surgical procedure due to infection recurrence, yielding a recurrence rate of 12.4%. However, researchers found no significant differences between the groups in terms of the presence of potential risk factors except in the volume of irrigation. The authors noted the volume of irrigation as the most significant finding of the study and “was a critical factor for eradicating infection in adult septic arthritis of a native shoulder joint.”
“There have been some reports specifically dealing with arthroscopic treatment of septic arthritis of the shoulder; however, no study has reported on the volume of irrigation,” the authors wrote. “Our results showed that patients with septic arthritis of native shoulder joints had to undergo massive irrigation (16.8 L or greater) to eradicate infection in a single arthroscopic surgical procedure.” – by Casey Tingle
Disclosures: The authors report no relevant financial disclosures.
Perspective
Back to Top
Paul M. Sethi, MD
Yong-Bum Joo, MD, PhD, and colleagues retrospectively report on the largest published series of treatment for native septic arthritis in 97 patients over a 12-year span. Unlike the challenges associated with the diagnosis of infection after shoulder arthroplasty, the authors describe a clear diagnosis of native shoulder infection including elevated serum markers, joint effusion and a suppurative aspiration.
The authors identified the single factor associated with eradication in a single washout was the volume of irrigant used. This study found 16.8 L were used in in the successful group vs. 10.8 L in the recurrent infection group. Medical comorbidities did not seem to play a role.
It is unclear if any detergent or antibiotic was used in the irrigation and if duration of infection prior to lavage played any role. It is also interesting that, while Staphylococcus aureus was the most common organism, only 37% of patients had a causative organism identified.
Joo’s paper underscores the importance of a thorough debridement and challenges the unvetted norm of between 6 L and 9 L irrigation.
The Orthopaedic and Neurosurgery Specialists Sports and Shoulder Service
Read more about
Click Here to Manage Email Alerts