Abstract
PurposeTo assess the feasibility of needle arthroscopy for management of suspected bacterial arthritis in native joints.MethodsDuring a pilot period, patients presenting with symptoms suggestive of native joint bacterial arthritis were eligible for initial management with needle arthroscopy. Procedures were performed in the operating theatre or at the patient bedside in the emergency department or inpatient ward. As our primary outcome measure, it was assessed whether needle arthroscopic lavage resulted in a clear joint. In addition, the need for conversion to standard arthroscopy or arthrotomy, the need for conversion from local to general anaesthesia, complications and the need for additional surgical intervention at follow-up during admission were recorded.ResultsEleven joints in 10 patients (four males, age range 35 – 77) were managed with needle arthroscopy. Needle arthroscopic lavage resulted in a clear joint in all cases. Conversion to standard arthroscopy or arthrotomy was not needed. Seven procedures were performed at the patient bedside using local anaesthesia. These procedures were well tolerated and conversion to general or spinal anaesthesia was not required. There were no procedure complications. One patient received multiple needle arthroscopic lavages. No further surgical interventions beside the initial needle arthroscopic lavage were required for successful management in other cases.ConclusionsNeedle arthroscopy can be a feasible tool in the initial management of complaints suggestive for native joint bacterial arthritis, providing an effective, quick and well-tolerable intervention in the operating theatre or at the patient bedside, with the potential to relief health systems from need for scarce operating theatre time.
Highlights
A suspected bacterial infection of a native joint – so called septic or bacterial arthritis – requires urgent management to control potential life-threatening sepsis and reduce the risk of cartilage destruction
In a pilot period between January 2020 and December 2020, all adult (18 years of age or older) patients presenting to the Orthopedic Surgery department of our university hospital (Amsterdam UMC, Amsterdam, The Netherlands) with a clinical suspicion of bacterial arthritis of a native joint were eligible for initial management using needle arthroscopy
Needle arthroscopy led to successful lavage in all cases (Fig. 1), without a need for conversion to standard arthroscopy or arthrotomy
Summary
A suspected bacterial infection of a native joint – so called septic or bacterial arthritis – requires urgent management to control potential life-threatening sepsis and reduce the risk of cartilage destruction. Initial management of a suspected bacterial arthritis consists of joint drainage, followed by antibiotic therapy [7]. Several options are commonly used to drain a bacterially infected. Recent technical innovation offers the possibility of 1.9-mm diameter arthroscopy with a disposable and portable arthroscope [13]. This needle arthroscopy uses a tablet for image processing whilst the needle arthroscope can be connected to syringes for distention and Stornebrink et al J EXP ORTOP (2021) 8:67 rinsing of the joint. Only small (2.3-mm) portals are required, which are expected to be acceptable for the patient under local anaesthesia [11–13]
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