Septic Arthritis Of Knee Research Articles

Clinical effects of staged joint replacement in patients with septic arthritic knee

ObjectiveTo assess the clinical effect of staged joint replacement for the treatment of septic arthritic knee and the therapeutic differences between antibiotic cement beads and the tibial plateau spacer.MethodsTwenty-three patients (24 knee joints) treated with a staged joint replacement for septic arthritis knee were retrospectively reviewed between March 2014 and April 2018. At the first stage, thorough debridement and irrigation with self-made antibiotic cement beads or tibial plateau spacer were performed. After that, systemic antibiotic treatment was followed; when the infection was surely eliminated, the second-stage TKA was performed. Knee mobility (range of motion, abbreviated to ROM) and function (HSS scores system) were evaluated before surgery, in the interval period, and after joint replacement.ResultsAll patients finished follow-up, and the mean follow-up time was 27.3 months (12–54 months). Each group has one patient replaced with a homotypic spacer, and all patients eventually cleared the infection. None of the patients had a recurrent infection. The mobility and HSS scores of the two groups were significantly improved postoperation (p < 0.05). And there was no significant difference in the post-surgery ROM (p = 0.153) and the HSS score (p = 0.054) between the two groups.ConclusionStaged joint replacement is an efficacious way for septic arthritic knees, whether tibial plateau spacer or antibiotic cement beads were used, which can effectively control infection and improve knee function.

A 10 Year clinical, laboratory and arthroscopic data analysis of bacterial septic arthritis of adult native knee: A hospital-based study

ObjectiveA hospital-based study was conducted to analyze the clinical, laboratory and arthroscopic data of bacterial septic arthritis of the native knee in adults treated over ten years. MethodBetween 2010 and 2019, the clinical, laboratory and arthroscopic data of all adult patients who underwent Arthroscopic debridement for diagnosed or suspected septic arthritis of the knee were reviewed from the medical records. Statistical analysis was performed to compare these characteristics between positive and negative cultures and between patients with or without co-morbidities. Further, these characteristics were also compared between patients who had Staphylococcus aureus infection versus non-Staphylococcal infection. ResultsThe data from 106 cases comprising of 86 males and 20 females were analyzed. The mean age of the study population was 51.04±15.38 years. Positive cultures were observed in only 38 cases (35.84%). Between positive and negative cultures, statistically significant differences were found for haemoglobin levels, CRP, total protein in the synovial fluid, duration of antibiotic course and length of hospital stay. Between patients with or without co-morbidities, statistically, significant differences were found for patients ‘age, haemoglobin levels, RBS, HbA1c, Serum Urea, Creatinine, ESR, CRP, the total duration of antibiotic course and length of hospital stay. No major differences were observed between patients with Staphylococcus aureus related and non-Staphylococcus aureus related infections. ConclusionIn most of the cases no organisms were isolated from the synovial fluid or the tissues. Among the positive cultures, Staphylococcus aureus was the most common organism isolated, with nearly half of them (42.8%) being MRSA. Patients with positive cultures and associated medical co-morbidities were treated with a longer duration of the antibiotic course and had a longer hospital stay. Awareness among the clinicians and microbiologists about the new emerging infections in the native knee is vitally important.

SYMPTOMATIC PULMONARY AND INTRACRANIAL NODULES IN A PATIENT WITH LONGSTANDING, UNCONTROLLED RHEUMATOID ARTHRITIS

SESSION TITLE: Medical Student/Resident Pulmonary Manifestations of Systemic Disease Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Pulmonary manifestations of rheumatoid arthritis (RA) are found in 60-80% of all RA patients and are responsible for 10-20% of RA-related mortality. RA nodules are observed in approximately 20% of RA patients with 20- 32% prevalence pulmonary RA nodules. Rarer intracranial RA nodules have been described in two case studies.1 Here we present a patient who demonstrates significant symptomatic pulmonary nodulosis along with intracranial nodules leading to intractable seizures and ventilator support. CASE PRESENTATION: Our patient was a 67-year-old woman with a 9-year history of RA, recurrent bilateral knee septic arthritis, and three months of focal seizures who presented to the emergency department for breakthrough focal seizures. Prior magnetic resonance imaging (MRI) showed contrast enhancing right temporal and right thalamic nodules up to 4mm consistent with electroencephalogram (EEG) localization of the seizures. Rheumatologically, the patient had RA flares multiple times per month despite maximal doses of hydroxychloroquine, leflunomide, and methrotrexate (MTX). 6 months prior, an outpatient Chest CT ordered for evaluation of dyspnea showed multiple solid and cavitary pulmonary lesions. Endobronchial ultrasound with biopsy of nodules showed necrotizing granulomatous inflammation consistent with RA nodules. During hospitalization, the patient presented with mildly elevated CRP, RF, and anti-CCP, and mildly decreased complement C3 but otherwise normal exam and negative serologic and cerebrospinal fluid tuberculosis, fungal, bacterial, viral, cancer and autoimmune workup. Repeat imaging showed multiple new bilateral pulmonary nodules up to 2.3 cm with stable intracranial nodules despite empiric acyclovir. The patient continued to have seizures in the unit despite maximal doses of intravenous seizure medication, six days later developing, ultimately fatal severe metabolic acidosis, bradycardia, and hypotension. DISCUSSION: This unique case of symptomatic intracranial and pulmonary nodules in the setting of RA does not have much literature accompaniment, but we hope to add our experience to a potential disease etiology. Several case reports, however, do show reduction in pulmonary nodule size with oral steroid courses. There is currently no strong consensus on treatment of RA nodules. While RA nodules are often considered relatively benign, in this patient the EEG and imaging finding suggest that the nodules may have significantly contributed to this patient’s breakthrough seizures. Unfortunately due to this patient’s comorbidities and tenuous medical status, pathologic review of the brain lesions was not obtained. CONCLUSIONS: This report highlights the need to consider RA as a potentially reversible cause when considering unexplained systemic findings, as well as the need for more research into treatment of extraarticular manifestations of RA. Reference #1: Esposito AJ, Chu SG, Madan R, Doyle TJ, Dellaripa PF. Thoracic Manifestations of Rheumatoid Arthritis. Clin Chest Med 2019;40(3):545–560. DISCLOSURES: No relevant relationships by Oleh Hnatiuk, source=Web Response No relevant relationships by adarsh vangala, source=Web Response No relevant relationships by Nicholas Villalobos, source=Web Response

SEPTIC ARTHRITIS IN A FOURTEEN DAY OLD NEWBORN CLINICAL APPROACH AND TREATMENT STRATEGIC

Objective: We present a case of osteoarthritis in a four teen day old newborn who underwent aspiration and drainage on the fifth day after admission instead of on the first day. The aim of this case report is to describe the importance of a team approach and clinical management algorithms for the successful treatment of septic arthritis in newborn.&#x0D; Case report: We describe a 3200g male baby, who treated with antibiotics and underwent aspiration and drainage on the fifth day after admission to our Unit for septic arthritis of the right knee. After the surgical drainage of the joint, signs of flammation began to improve. Results of culture of pus in the knee joint is Staphylococcus aureus. The child was discharged after 14 days of treatment.&#x0D; Conclusion: Septic arthritis requires early diagnosis, prompt administration of antibiotics and rapid removal of pus by surgical treatment, due to joint infections can progress seriously and irreversible consequences even death. The combination of neonatal specialty and orthopedic trauma specialist is necessary to successfully treat septic arthritis in newborns.&#x0D;

Plasma C3d levels as a diagnostic marker for complete complement factor I deficiency

Plasma C3d levels as a diagnostic marker for complete complement factor I deficiency

Can predictors of Pediatric Septic Hip be applied to the Knee

Purpose: The early diagnosis and treatment of septic arthritis in pediatric patients are paramount to the prevention of long-term sequela. While much of the literature has focused on markers of the hip, little is known of the application of these to the knee. The purpose of this study is to investigate if the Kocher criteria can be used for screening children suspicious to have septic arthritis of the knee. Methods: We retrospectively reviewed the charts of male and …

Two-stage Total Knee Arthroplasty for Treatment of Surgical Failure of Septic Arthritis in Degenerative Knee Joints.

The ultimate goal of the treatment of infectious knee arthritis is to protect the articular cartilage from adverse effects of infection. Treatment, however, is not always hundred percent successful and has a 12% failure rate. Persistent infection is more likely to happen in elderly patients and those with underlying joint diseases, particularly osteoarthritis. Eradication of infection and restoration of function in the involved joint usually are not possible by conventional treatment strategies. There are few case series reporting two-stage primary knee arthroplasty as the salvage treatment of the septic degenerative knee joint; however, the treatment protocol remains to be elucidated. Based on a proposed approach, patients with failure of common interventions for treatment of septic knee arthritis and underlying joint degeneration were treated by two-stage TKA and intervening antibiotic loaded static cement spacer. Suppressive antibiotic therapy was not prescribed after the second stage. Complete infection eradication was achieved with mean follow up of 26 months. All cases were balanced with primary total knee prosthesis. The knee scores and final range of motions were comparable to other studies. The two-stage total knee replacement technique is a good option for management of failure of previous surgical treatment in patients with septic arthritis and concomitant joint degeneration. Our proposed approach enabled us to use primary prosthesis in all of our patients with no need for suppressive antibiotic therapy.

El desbridamiento por artrotomía de la artritis séptica de rodilla artrósica es más eficaz que el artroscópico y retrasa la necesidad de prótesis a pesar de la progresión de la artrosis

Background and objective40%-50% of this septic arthritis occurs in the knee, despite rapid medical surgical treatment, 24%-50% will have a poor clinical outcome. It is not clear which debridement technique, by arthrotomy or arthroscopy, is more effective in controlling infection, or whether or not previous osteoarthritis worsens the outcome. The objective of this study on septic arthritis of the osteoarthritic knee was to analyse which surgical debridement technique, arthroscopy or arthrotomy, is more effective, the clinical and radiographic outcomes of the patients, and how many go on to require a TKR after the infection has healed. Material and methodsA retrospective study was performed in 27 patients with native septic arthritis of the knee. Eighteen were men and the mean age was 64.8 years (30-89years). Fifteen patients were debrided by arthrotomy and 12 by arthroscopy. The effectiveness of debridement in controlling infection, the radiographic progression of the osteoarthritis on the Ahlbäch scale, the need for subsequent replacement, and pain and functional status were analysed using the VAS and WOMAC scales at 52.8±11.2-month follow-up. ResultsThe infection was controlled in 93% and 92% of the patients, 13% and 42% required 2 or more surgeries for infection control, 18% and 44.4% showed progression of arthritis in the arthrotomy and arthroscopy groups, respectively. One patient in each group required a knee replacement. The VAS score was superior in the arthrotomy group and there were no differences in WOMAC score. ConclusionDebridement by arthrotomy in the emergency department by non-sub-specialist knee surgeons is more effective than arthroscopic debridement in controlling septic arthritis of the knee. Surgical debridement of septic arthritis in knees with previous osteoarthritis enabled control of the infection with no pain despite the progression of the osteoarthritis.

Two-Stage Primary Arthroplasty of Native Hips and Knees That Had Previously Failed Treatment for Septic Arthritis: A Single-Center Experience.

BackgroundPatients with a history of degenerative joint disease secondary to an acute or remote episode of septic arthritis of the native knee or hip present a unique challenge for the orthopaedic surgeon. This study describes our experience with two-stage primary arthroplasty for such patients.MethodsWe reviewed 42 patients with a history of septic arthritis treated with two-stage primary arthroplasty between 2008 and 2018. Patients were evaluated using modified Harris Hip Score, Knee Society Score (KSS), and KSS functional component (KSSF). Paired t-tests were used to compare changes for continuous variables within cohorts. Multivariate linear and logistic regression models were constructed to determine predictors of outcomes and complications.ResultsAt a mean of 3.3-year follow-up, there were 14 (33.3%) complications and the infection cure rate was 95.2%. On average, patients improved in the modified Harris Hip Score (42.9 ± 11.8 vs 83.3 ± 11.1, P < .001), KSS (35.9 ± 16.9 vs 80.1 ± 16.6, P < .001), KSSF (38.0 ± 15.1 vs 71.5 ± 24.0, P < .001), knee flexion (90.9 ± 14.9 vs 100.5 ± 17.1), and hip flexion (73.8 ± 21.2 vs 102.1 ± 11.8, P < .001). Age (β: −0.78, P = .004) was independently associated with lower Harris Hip Score in the hip cohort. There were no independent predictors of the KSS or KSSF. The erythrocyte sedimentation rate (odds ratio: 1.07, P = .043) and C-reactive protein (odds ratio: 1.43, P = .018) at stage 2 were independently associated with a higher likelihood of complications at the final follow-up.ConclusionPatients with a history of native septic arthritis of the hip and knee, and secondary end-stage degenerative joint disease, showed significant postoperative improvements and a high rate of complications after two-stage primary total joint arthroplasty. Despite improvements, some patients may necessitate a third operation because of the incidence of reinfection and spacer exchange. This information should be used to counsel patients who present with this challenging clinical scenario.

A two-stage approach to primary TKA using articulating antibiotic-loaded spacers improve function and eradicate infection in septic arthritic knees.

The treatment of an infected arthritic knee might be challenging. The failure rate has been reported to be high for open or arthroscopic debridement. A subsequently high rate of infection has been noted in these patients undergoing primary total knee arthroplasty (TKA). In the present study, a two-stage approach using an articulating spacer was used. The hypothesis was that the procedure would eradicate the infection and improve pain and function in these patients. A total of 16 consecutive patients were enrolled in this retrospective study. The mean follow-up time was 6.1years (range 2.0-9.9years). Patients with advanced osteoarthritis and infection of the knee were included. All patients had previously undergone one or more failed arthroscopic or open procedures for the eradication of infection. All patients received the same homemade metal-on-plastic articulating antibiotic spacer. Double antibiotic therapy was given for 2weeks intravenously and orally for 4weeks. TKA implantation was performed 6weeks after the first stage. The infection was eradicated without recurrence in all patients. The functional results were significantly improved, and pain was significantly reduced after spacer and TKA implantation. The mean amount of knee flexion was 95 ± 30° preoperatively, and it increased to 109 ± 14° (p = 0.012) after spacer implantation and to 119 ± 10° (p = 0.002) after TKA implantation. The mean KSS objective was 58 ± 12 preoperatively, and it increased to 75 ± 14 (p < 0.0001) after spacer implantation and to 96 ± 3 (p < 0.0001) after TKA implantation. The mean KSS function was 17 ± 11 preoperatively, and it increased to 46 ± 10 (p < 0.0001) after spacer implantation and to 86 ± 6 (p < 0.0001) after TKA implantation. The mean VAS score was 65 ± 11 preoperatively, and it decreased to 2 ± 4 (p < 0.0001) after spacer implantation and to 1 ± 2 (p < 0.0001) after TKA implantation. The two-stage procedure for the treatment of infected arthritic knees after failed eradication surgery was effective in all patients. Using an antibiotic articulating metal-on-plastic cement spacer showed improved functional results between the stages and at the final follow-up. No intra- or postoperative complications occurred.

Resident Involvement Is Not Associated With Increased Risk of Postoperative Complications After Arthroscopic Knee Surgery: A Propensity-Matched Study

To investigate whether resident involvement in knee arthroscopy procedures affects postoperative complications or operative times. The American College of Surgeons National Surgical Quality Improvement Program registry was queried to identify patients who underwent common knee arthroscopy procedures between 2006 through 2012. Patients with a history of knee arthroplasty, septic arthritis or osteomyelitis of the knee, concomitant open or mini-open procedures, or without information on resident involvement were excluded. A 1:1 propensity score match was performed based on age, sex, obesity, smoking history, and American Society of Anesthesiologist classification to match cases with resident involved to nonresident cases. Fisher exact tests, Pearson's χ2 tests, and Wilcoxon rank sum tests were used to compare patient demographics, comorbidities, and 30-day complications. Wilcoxon rank sum tests were used to compare operative time and length of hospital stay between the 2 groups, with statistical significance defined as P < .05. After matching, 2954 cases (50% resident involvement) were included in the study with no significant differences in demographics or comorbidities between the 2 cohorts. The overall rate of 30-day complications was 1.1% in the nonresident and resident involved group (P= 1.000). There was no significant difference in postoperative surgical (nonresident vs resident involved: 0.48% vs 0.83%, P= .2498) or medical (nonresident vs resident involved: 0.62% vs 0.83%, P= .5111) complications. However, knee arthroscopy cases that residents were involved with had significantly longer operative times (69.8 vs 66.8 minutes, P= .0002), and length of hospital stay (0.85 vs 0.21 days, P= .0332) when compared with cases performed without a resident. Resident involvement in knee arthroscopy procedures is not a significant risk for medical or surgical 30-day postoperative complications. Resident participation in knee arthroscopy was associated with statistically significant but likely clinically insignificant increased operative time as well as length of hospital stay. Level III: Retrospective Cohort Study.

Arthrodesis with Retrograde Intramedullary Nail for Recurrent Infected Total Knee Arthroplasty with Patellar Tendon Rupture: A Case Report and Literature Review

Patellar tendon rupture after total knee arthroplasty is a rare, but often catastrophic complication. In addition, infection is also a dreaded complication after total knee arthroplasty. We report an 84-year-old female that has late infected total knee arthroplasty with patellar tendon rupture treated with resection arthroplasty and then subsequent arthrodesis with retrograde intramedullary nail.Case Presentation:The 84-year-old female underwent left total knee arthroplasty 2 years ago and revision arthroplasty last year after trauma. She presented to the emergency department with painful disability of left knee. The septic arthritis of left knee was confirmed by bacterial culture through arthrocentesis which yielded methicillinsensitive staphylococcus aureus. Patellar tendon rupture was also noted by loss of extension mechanism and patella alta in plain films. Despite attempts on open debridement and parenteral antibiotics, the infection did not settle. Resection arthroplasty with vancomycin- impregnated cement spacer implantation was performed following by 4-week parenteral antibiotics therapy. The ESR and CRP level of serum improved gradually. Arthrodesis of left knee with retrograde locking intramedullary femoral nail through single incision of the knee was performed. Protected weight bearing was allowed in one week after arthrodesis. The patient discharged 2 weeks later without recurrent infection, but leg length discrepancy about 2cm was noted.Discussion:Patellar tendon rupture after total knee arthroplasty is a rare but disabling complication whose management is often difficult. It was reported that incidence of patellar tendon rupture in literature varies between 0.3- 12.4% for primary total knee arthroplasty and between 1-15% for revision total knee arthroplasty. Contributing factors are excessive dissection and knee manipulation, and trauma. In the literature, various different operative techniques and rehabilitation programs have been described indicating the lack of a golden standard treatment protocol. However, in patients with a total knee arthroplasty, the results have been discouraging. Reconstruction of the patellar tendon can be utilized semitendinosus-gracilis graft with an interference screw and a staple fixation in treating acute ruptures, whereas allografts and synthetic mesh are indicated for chronic cases. Nevertheless, treatment outcomes for ruptured patellar tendon are not good. Gold standard treatment of infected total knee arthroplasty was resection arthroplasty with antibiotic-impregnated bone cement spacer and parenteral antibiotics therapy and then second stage revision total knee arthroplasty until the infection is eradicated. The patella tendon repair and second revision arthroplasty were not suggested by Jake et al. Patellar tendon rupture is best treated with primary repair, but infected prosthetic knee with patellar tendon rupture seemed to be more difficult to manage. Arthrodesis but not revision arthroplasty may be the best choice after infection control to improve the patient’s level of function.

CHALLENGES IN SMALL KNEE ARTHROSCOPY: A QUALITATIVE AND QUANTITATIVE PEDIATRIC CADAVERIC EXPERIENCE

Background:Arthroscopy may be utilized for treatment of septic arthritis of the pediatric knee, with success reported in ages from 3 months to 12 years. There is limited data on the ability to arthroscopically assess articular structures and ensure adequate evaluation without arthrotomy.Hypothesis/Purpose:The purpose of this study is: (1) utilize arthroscopy in small cadaveric knees to improve qualitative and quantitative knowledge of pediatric articular structures and (2) to obtain pilot data for common procedures performed in pediatric patientsMethods:Five small pediatric cadaveric specimens (1-4 years) underwent arthroscopy (2.7 mm Stryker arthroscope). Medial and lateral compartments were assessed for meniscus size/mobility/height, compartmental joint space, ACL insertion, patellar chondral height and length, and position of the medial patellofemoral ligament were recorded. Utilizing standard anterior medial and lateral portals, the ability to visualize the structures of the posteromedial and posterolateral compartments was recorded. Procedures pertinent to immature ACL reconstruction and meniscal repair (unstable discoid) were critically evaluated to provide source data for future work.Results:Prior to arthroscopy, all specimens underwent volume-assessed knee insufflation (average 11.4 cc normal saline). Arthroscopic visualization of the menisco-capsular attachment was possible posteromedially in 4/6, and posterolaterally in 5/6 knees. Qualitative arthroscopic relationships were similar to adult references; including patellar-trochlear articulation and lateral meniscal positional relationship to the ACL insertion (see Figure 1). The ACL center was within 2 mm of the posterior aspect of the anterior horn of the lateral meniscus in all specimens. The average height of the medial compartment space under valgus load was 1.5 mm (1 – 2 mm), and lateral space under varus was 2.2 mm (2-3 mm); further emphasizing the need for small joint instruments. The width of the medial and lateral menisci are noted in Table 1. All-inside meniscal devices designed for skeletally mature specimens should be used with caution (Figure 1). Traditionally described inside-out technique for immature ACL reconstruction with an iliotibial band demonstrated significant proximity of the passing device to the neurovascular bundle (Figure 1).Conclusion:The entirety of the small knee is assessable via standard diagnostic arthroscopy, when a 2.7mm arthroscope is utilized. These findings suggest that intra-articular pathology can be reliably identified utilizing this surgical technique. However, the ability to work on the infant meniscus and cartilage with standard arthroscopic instruments is likely limited given the constraints of joint height.Table 1.Meniscal width of the medial and lateral meniscus as measure by a microprobe. Figure 1.Arthroscopic and gross images of an infant cadaveric knee 11 year old). (A) ACL insertion into the tibia. Note the relationship of the anterior horn of the lateral meniscus to the ACL Insertion. (B) The patellocrochiear articulation with a well formed troctilea, (C) Medial patellofemoral ligament as it inserts onto the patella. Marking in the ligament 1') indicates centroid of the ligament based on superficial anatomy. (D) Pilot study of placement of an all-inside meniscal repair device (Stryker AIR) The size of implant is 70% of the height of the lateral meniscus, .1E) Image of a dissected popliteal fossa of a small knee. Curved clamp )black arrow) was placed as if to facilitate passage of the !Thin a extra-articular ACL reconstruction with the dicta:fiat hand. Note the proximity to the posterior neurovascular structures (Yellow = artery; blue = nerve).

Are Patients With a History of Septic Arthritis Undergoing Total Knee Arthroplasty at Higher Risk for Revision Surgery? A Single-Center Study

BackgroundThe decision to perform a total knee arthroplasty (TKA) on a previously infected knee is made complicated by the higher risk for both a periprosthetic joint infection (PJI) and early failure. There is currently no standard in the treatment strategy for this group of patients. We here report the outcomes of performing a primary TKA on patients with a prior septic knee arthritis. The aim of our study is to analyze the survival rates of patients with a history of septic arthritis undergoing TKA. MethodsFrom 2010 to 2018, all patients treated in our institution with a minimum follow-up of 1 year, who have previous histories of knee joint infections and underwent a primary TKA were included in the study. All patients underwent the same surgical protocol and were given systemic and local antibiotic treatment. ResultsOf the 68 knees, there were 4 surgical revisions (5.9%). These included 2 septic revisions due to PJI (2.9%), 1 open arthrolysis for arthrofibrosis (1.5%), and 1 aseptic revision for implant loosening (1.5%). Sixty-four (64) knees (94%) had survived without any surgical interventions and the Kaplan-Meier analysis demonstrated an overall survivorship free from PJI of 97.1% at a mean of 5 years (range 1-9, standard deviation ±2.5 years). ConclusionTKA is a suitable option for patients with a prior septic arthritis of the knee, provided that proper surgical technique and the utilization of systemic and local antibiotics are employed. Level of EvidenceLevel III, therapeutic study.

Osteomyelitis of the Knee Following Intra-Articular Injections: A Case Series

Septic arthritis of the knee is rare in adults. This leads to difficulty in making early diagnosis that invariably leads to delayed treatment with consequent destruction of the joint. The delay in diagnosis is largely attributed to absence of clinical signs of flagrant infection. Reported are three adult patients who presented with painful swollen knee and inability to walk few weeks after intra-articular injection for osteoarthritis. This paper discusses the cases in which the difficulties in the early diagnosis of septic arthritis of knee in adults led to the development of osteomyelitis.

Knee infection following anterior cruciate ligament reconstruction: a cohort study of one thousand, eight hundred and ninety one patients from the single-centre database.

This study was undertaken to retrospectively determine the incidence of postoperative knee infection following ACL reconstruction, to identify the most common causative pathogen and to evaluate our diagnostic and treatment approach, as well as to review current recommendations for the management of septic arthritis. From January 2007 to December 2017, a total of 1891 arthroscopic ACL reconstructions were performed at our institution. Twenty-nine cases with clinical suspicion of post-operative septic knee arthritis following ACL reconstruction were identified and retrospectively analysed with regard to incidence, clinical presentation, microbiological spectrum, laboratory parameters and number of arthroscopic debridements. Three patients were classified as aseptic effusion and were excluded from the further analysis. Patients were treated with antibiotic therapy (IV and oral) and repeated arthroscopic debridement. Twenty-six (1.4%) out of 1891 patients were diagnosed with joint infection and were treated with arthroscopic debridement and intravenous antibiotics. Inthe majority of cases (58.69%), microbiological analysis failed to identify the causative pathogen and in those where the pathogen was isolated, the most common was methicillin-resistant Staphylococcus epidermidis (45.45%). Mean time interval from reconstruction to onset of symptoms was 23.54 ± 21.00 (6-100) days. The mean number of arthroscopic irrigations and debridements was 1.23 ± 0.51 (1-3) per patient. In all, twenty-six cases of graft was retained. Septic arthritis following ACL reconstruction is a rare but serious complication. We conclude that prompt treatment consisting of repeated arthroscopic irrigation and debridement with course of antibiotic therapy is an effective therapeutic intervention that leads to graft and hardware retention.

Surgical Options and Approaches for Septic Arthritis of the Native Hip and Knee Joint

Septic arthritis (SA) of the adult knee and hip is a constantly evolving and urgent surgical issue. The epidemiology has shifted over the last few decades as have the most popular antibiotics and surgical treatments. SA of all types is increasing in the United States. There remains a high variability in the conservative and surgical management options available. This review will outline the most current understanding of the etiology and epidemiology of SA and will also discuss the distribution of causative organisms and appropriate treatments for each. A summary of evidence for different debridement and reconstructive techniques will also be presented in addition to novel areas of research to decrease the morbidity of this constantly growing problem.

Mortality and adverse joint outcomes following septic arthritis of the native knee: a longitudinal cohort study of patients receiving arthroscopic washout

The short-term and long-term consequences of septic arthritis are uncertain. We aimed to determine risk of mortality and adverse joint outcomes following septic arthritis of the native knee. We did a retrospective cohort study in patients who received arthroscopic knee washout for septic arthritis in England between April 1, 1997, and March 31, 2017, using data in the national Hospital Episode Statistics database. Patients with previous knee surgery to the same knee were excluded. Mortality within 90 days, adverse joint outcomes (arthrodesis, amputation, arthroplasty) within 1 year, and arthroplasty within 15 years were determined. Mortality in patients with a primary admitting diagnosis of septic arthritis (ICD-10) was compared with that in patients in whom septic arthritis was a secondary diagnosis. 12 132 patients were included (mean age 56·6 years [SD 24·9]) of whom 4307 (36%) were female. In 10 195 (84%) patients with septic arthritis as the primary admitting diagnosis, 90-day mortality was 7·05% (95% CI 6·56-7·57; 719 patients), rising to 22·69% (20·80-24·68; 418 patients) in 1842 patients older than 79 years. Secondary septic arthritis diagnosis versus primary diagnosis was associated with an adjusted odds ratio for mortality of 2·10 (95% CI 1·79-2·46; p<0·0001). In 11 393 patients with at least 1 year follow-up, the 1 year rates were 0·13% (95% CI 0·07-0·22; 15 patients) for arthrodesis, 0·40% (0·30-0·54; 46 patients) for amputation, and 1·33%; (1·13-1·56; 152 patients) for arthroplasty. Within 15 years, 159 (8·76%; 95% CI 7·50-10·15) of 1816 patients had received arthroplasty, corresponding to an annual risk of arthroplasty that was about six times that of the general population (risk ratio 6·14, 95% CI 4·95-7·62; p<0·0001). The consequences of septic knee arthritis in patients undergoing arthroscopic knee washout are serious. These findings highlight the potentially devastating outcomes associated with sepsis from musculoskeletal joint infection. National Institute for Health Research.

Repeat irrigation & debridement for patients with acute septic knee arthritis: Incidence and risk factors

BackgroundSeptic knee arthritis is considered an orthopedic emergency due to its significant morbidity and potential to be life-threatening. One important outcome in treatment of septic knee arthritis is whether return to the operating room for repeat irrigation and debridement is required. This complication presents extra burden to the patient, as well as to the health care system. This study aims to first isolate the incidence of repeat irrigation and debridement at the authors’ home institution and then define risk factors for repeat washout for septic arthritis of the knee. MethodsRecords from all patients at a single academic institution with acute septic knee arthritis who had arthroscopic or open I&D of the knee joint from January 2005–December 2015 were collected retrospectively. Patients were initially identified on the basis of diagnosis coding in the institution’s medical information system. Following collection/screening based on strict inclusion/exclusion criteria, a cohort of 63 patients was ultimately included. 18 patients were assigned to a “repeat washout” (RW) cohort and 45 patients were assigned to a “no repeat washout” (NRW) cohort. Univariate analyses and multivariable regression models were performed between the two washout cohorts to identify variables associated with repeat washout. ResultsPatients requiring a repeat washout (RW) had a statistically significant association with African American/Hispanic race, higher BUN levels, higher serum white blood cell (WBC) count on admission, concurrent infection, and isolated bacteremia when compared to those patients who did not require a repeat washout (NRW) (all respective P < 0.05). Multivariable regression analysis demonstrated concurrent infection and higher synovium WBC count to increase the risk for another repeat washout. Patients who had a concurrent infection were shown to have nearly 12-fold higher odds of needing a repeat washout than those without a concurrent infection (95% CI:2.40–56.88; P = 0.0023). For every 1000 unit increase in synovium WBC count, the odds of needing a repeat washout increased by 1% in patients with concurrent infection (95% CI:1-2%; P = 0.0168). ConclusionThis study retrospectively isolated risk factors associated with repeat surgical lavage. In the multivariable regression analysis, both concurrent infection and increased synovial WBC count were significantly associated with the need for repeat knee I&D. This finding is significant, as it may signify a potential for increased infectious resilience for acute septic arthritis of the knee secondary to seeding from systemic infection, thus requiring multiple I&Ds to meet resolution. This finding may carry clinical significance in the early stages of patient counseling regarding hospital course and prognosis. Level of evidenceIV.

Arthroscopy versus arthrotomy for the treatment of septic knee arthritis

PurposeTo compare complications following arthroscopy and arthrotomy for treatment of septic knee arthritis. MethodsPatients undergoing arthroscopy and arthrotomy for a diagnosis of septic knee arthritis were identified in National Surgical Quality Improvement Program and placed in a multivariate analysis to determine if type of surgery contributed to postoperative complications. ResultsKnee arthrotomy was associated with an increased risk for increased operative time [Parameter estimate 4.555 (95% CI:3.023–6.085); p < 0.0001], minor morbid events [OR 2.064 (95% CI: 1.447–2.943); p < 0.0001], and any morbidity [OR 2.285 (95% CI:1.527–3.419); p < 0.0001]. ConclusionsKnee arthrotomy was associated with a higher risk of complications.