Abstract
Septic arthritis is common in older adults and can be related to joint surgery or hematogenous distribution. To date, the risk factors affecting survival are unknown. This study aimed to evaluate the effects of existing implants, positive synovial microbiological culture results, and the American Society of Anesthesiology Physical Status (ASA) classification on the short- and mid-term survival of older patients with primary septic gonarthritis. This retrospective study included 133 older adults >60 years who underwent surgery for primary septic gonarthritis. Data were collected from medical records and public obituaries. Kaplan–Meier survival curves were used to estimate the probability of survival, as well as log-rank tests to measure and compare survival rates over one- and five-year periods. The mean age was 74.9 years (SD ± 9.2), and the 5-year follow-up rate was 74.3% (the mean follow-up was 3000.5 days; SD ± 1771.6). Mean survival was significantly different in patients with implants and without implants (p = 0.015), and between ASA II, ASA III, and ASA IV (p < 0.001). There was no significant difference in the survival of patients with or without a positive synovial microbiological culture (p = 0.08). Older adults with septic monoarthritis and pre-existing medical implants showed impaired survival. The ASA classification prior to surgery for primary septic monoarthritis can be helpful in identifying patients with poorer mid-term outcomes.
Highlights
Septic arthritis is predominantly found in older adults and children and involves large joints such as the knees, hips, and shoulders [1]
The main findings of this study are that survival was found to be significantly impaired in older adults with septic gonarthritis and pre-existing medical implants, compared to older adults with septic gonarthritis who did not have implants
Older adults categorized as Anesthesiology Physical Status (ASA) II–ASA IV showed significantly decreased survival rates at the
Summary
Septic arthritis is predominantly found in older adults and children and involves large joints such as the knees, hips, and shoulders [1]. The causes of septic arthritis appear to be mainly exogenous, such as injury, iatrogenic injections, and invasive procedures [1–3]. The endogenous inoculation of bacteria from pre-existing bacteremia is described as a cause of septic arthritis [1–3]. The role of implanted joint prostheses as a reservoir for bacterial infections remains unclear [4,5]. Septic arthritis in joints with arthroplasties is associated with increased morbidity and poor functional outcomes [6]. Increasing age in patients with septic arthritis is considered a risk factor for developing complications, recurrences, an increased duration of immobility, and extended hospital stays in older patients diagnosed with septic arthritis [6,7]. It is believed that an inadequate immune response may make older adults more susceptible to serious illness and death from sepsis [8]
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