Septic Arthritis Of Knee Research Articles

The long-term time course of septic arthritis.

The aims of this study were to: 1) report on a cohort of skeletally mature patients with native hip and knee septic arthritis over a 14-year period; 2) to determine the rate of joint failure in patients who had experienced an episode of hip or knee septic arthritis; and 3) to assess the outcome following septic arthritis relative to the infecting organism, whether those patients infected by Staphylococcus aureus would be more likely to have adverse outcomes than those infected by other organisms. All microbiological samples from joint aspirations between March 2000 and December 2014 at our institution were reviewed in order to identify cases of culture-proven septic arthritis. Cases in children (aged < 16 years) and prosthetic joints were excluded. Data were abstracted on age at diagnosis, sex, joint affected (hip or knee), type of organisms isolated, cause of septic arthritis, comorbidities within the Charlson Comorbidity Index (CCI), details of treatment, and outcome. A total of 142 patients were confirmed to have had an episode of septic arthritis in a native hip (n = 17) or knee joint (n = 125). S. aureus accounted for 57.7% of all hip and knee joint infections. There were 13 inpatient deaths attributed to septic arthritis. The median age of the patients who died was 77.5 (46.9 to 92.2) and their median age-adjusted CCI was 8 (6 to 12). A failure of the joint occurred in 26 knees (21%) and nine hips (53%). Of the knee joints infected by S. aureus (n = 71), 23 knees (32%) went into failure of joint, whereas of those infected by other organisms (n = 54), only three knees (6%) failed. Based on our study findings, hip and knee septic arthritis long-term outcomes were substantially worse than their immediate outcome suggested. Failure of knee joint is 6.1 times more likely to occur in those infected with S. aureus.

A 78-Year-Old Female Presented with Chest Pain after Falling Down

&lt;p&gt;本文描述一位78歲的女性患者，因跌倒導致右側肋骨骨折，三週後因疑似胸腔延遲性出血合併膿胸入院，住院後發現個案右膝化膿性關節炎合併膿瘍及菌血症，在接受胸腔鏡右側肋膜清創術及針對個案狀況更換多次抗生素治療後，全身性的感染終獲得控制順利出院。針對診斷為創傷性血胸合併膿胸之患者，入院後右膝疼痛常被視為創傷合併之症狀，亦有可能是引起個案跌倒與延遲性出血導致右側膿胸的主因。因此針對患者所陳述的各種主訴與徵候，皆應詳細詢問病史與理學檢查，再綜合檢驗檢查結果的判斷，方能及早作出正確的鑑別診斷與治療計劃，也才能及時給予患者正確的治療，從而降低死亡率及後續可能產生的各種併發症。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;A 78-year-old female patient suffered from a right rib fracture due to a fall. Three weeks later, she was.admitted to the hospital with suspected delayed hemothorax and empyema. Through detailed medical history inquiry and evaluation based on subsequent CT scans and bacterial culture reports, it was con-firmed that she had septic arthritis of the right knee with an associated abscess and bacteremia. After undergoing thoracoscopic decortication of right pleura and multiple changes in antibiotic treatments tailored to her condition, the systemic infection was successfully controlled, and she was eventually discharged. In patients diagnosed with traumatic hemothorax complicated by empyema, the right knee pain upon admission is often considered a symptom of the trauma, but it could also be a signif-icant factor contributing to the patient&amp;rsquo;s fall and subsequent delayed bleeding leading to right-sided empyema. Therefore, it is essential to thoroughly inquire about the patient&amp;rsquo;s various complaints and symptoms, conduct a detailed medical history and physical examination, and then make a comprehen-sive judgment based on the results of laboratory and imaging tests to promptly establish an accurate differential diagnosis and treatment plan. This approach will enable timely and appropriate treatment for the patient, reducing the mortality rate and the potential occurrence of various complications.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review

AbstractPurposeSeptic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary objective of any treatment is complete source control. This commonly takes the form of antibiotic therapy and a washout of the infected joint by means of arthroscopy or arthrotomy. The primary aim of this review is to investigate if arthroscopic washout for native knee septic arthritis confers a lower risk of repeat procedure than arthrotomy.MethodsA systematic review and meta‐analysis was conducted of the MEDLINE, SCOPUS and the Cochrane Library data bases. The primary outcome of interest was requirement for repeat washout with all‐cause complications, length of inpatient stay and mortality secondary outcomes.ResultsA total of 17,140 subjects were included for analysis of the primary outcome, and the overall rate of repeat procedure was 14.6%. No statistical difference was found between arthroscopy and arthrotomy for repeat washout (risk ratio 0.86 [95% confidence interval, CI: 0.72–1.02], I2 = 36%). Eligible studies found in favour of arthroscopy for all‐cause complication rate (risk ratio 0.75 [95% CI: 0.6–0.93], I2 = 84%) and length of stay in hospital (mean difference −1.98 days [95% CI: −3.43 to −0.53], I2 = 84%). No statistical difference was found for the mortality rate (risk ratio 1.17 [95% CI: 0.52–2.63], I2 = 57%).ConclusionOur analysis found arthroscopy and open arthrotomy to be equivocal for repeat surgical washout in native knee septic arthritis. All‐cause complication rate and length of inpatient stay were favourable for arthroscopy with no difference noted between mortality rates.Level of EvidenceLevel III.

TOTAL KNEE ARTHROPLASTY FOLLOWING SEPTIC ARTHRITIS: A LONGITUDINAL STUDY OVER 20 YEARS

ObjectivesPost-infective arthritis is an important sequalae of septic arthritis(SA). While total knee arthroplasty(TKA) is an effective treatment for said arthritis, previous SA brings challenges for treatment planning. Using prospectively collected data from a cohort of patients with knee SA, this study aims to determine the proportion of patients requiring eventual TKA, and risk factors of developing prosthetic joint Infection(PJI).MethodsAll cases of 1st episode knee SA from 01/01/2000 to 31/12/2020 were identified in the Auckland region. Patient records and NZJR records of all cases were searched to identify subsequent TKA. PJI following arthroplasty was identified using ICM criteria.Univariate and multivariate analysis was performed to determine risk factors for developing PJI.Results854 cases of native SA were identified. Of these, 71 (8.3%) progressed to TKA. Average time from completion of SA treatment to TKA was 3.8 years (SD 3.4). At an average follow-up of 7.8 years(1–19.6), 11(15.5%) developed PJI and required reoperation in the form of; DAIR (n =5), revision (n= 6). A further 4 were readmitted for superficial infections. Five-year and ten-year implant survival was 90.0% and 87.1%, significantly lower than average survival of TKA in the NZJR (97.3% at 5 years and 95.7% at 10). Average time between completion of SA treatment and TKA was 2.1 years in those developing PJI, vs 4.1 years in those who did not(p = 0.0019). 4.8% of cases developed PJI when TKA was performed &gt;5 years after SA, compared with 20% risk of PJI within 5 years(p=0.16). Multivariate analysis showed no significant impact of pre-defined medical risk factors or demographic on outcomes.ConclusionA significant percentage of patients required TKA following knee SA. Time lapsed from SA treatment completion to TKA is an important risk factor for developing PJI.

Does arthroscopic or open washout in native knee septic arthritis result in superior post-operative function? A systematic review and meta-analysis of randomised controlled trials and observational studies

AimsSeptic arthritis (SA) of the native knee joint is associated with significant morbidity. This review compared post-operative functional outcomes (patient-reported outcome measures (PROMs) and range of movement (ROM)) following arthroscopic washout (AW) and open washout (OW) amongst adult patients with SA of the native knee. The need for further operative intervention was also considered.MethodsElectronic databases of PubMed, MEDLINE, Embase, Cochrane, Web of Science and Scopus were searched between 16 February 2023 and 18 March 2023. Randomised controlled trials (RCTs) and comparative observational analytic studies comparing function (reflected in PROMs or ROM) at latest follow-up following AW and OW were included. A narrative summary was provided concerning post-operative PROMs. Pooled estimates for mean ROM and re-operation rates were conducted using the random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias assessment tool-2 for RCTs and the Risk of Bias in Non-Randomized Studies of Interventions tool for observational analytic studies.ResultsOf 2580 retrieved citations, 7 articles (1 RCT and 6 cohort studies) met the inclusion criteria. Of these, five had some concerns/moderate risk of bias, and two had serious risk. There was a slight tendency for superior mean PROMs following AW compared with OW, but due to small effect sizes, this was unlikely clinically relevant. Additionally, the use of four different PROMs scales made direct comparisons impossible. AW was associated with superior ROM (mean difference 20.18° (95% CI 14.35, 26.02; p < 0.00001)), whilst there was a tendency for lower re-operation requirements following AW (OR 0.64, 95% CI 0.26, 1.57, p = 0.44).ConclusionsAW was associated with equivalent to superior post-operative function and lower requirement for further intervention compared with OW. Results need to be interpreted cautiously, taking into consideration the methodological and clinical heterogeneity of the included studies.Systematic review registrationPROSPERO 2022, CRD42022364062.

Two-stage total joint replacement for hip or knee septic arthritis: post-traumatic etiology and difficult-to-treat infections predict poor outcomes.

Septic arthritis (SA) is a rare but significant clinical challenge in orthopedics that can impact patients' quality of life. This study aims to examine the clinical outcomes of patients undergoing two-stage total joint replacement (TJR) in hip and knee SA and analyze potential predictors of treatment failure. A retrospective analysis was conducted using data from a prospectively collected institutional arthroplasty registry from January 1st, 2012, to January 1st, 2019. Patients with hip or knee SA who underwent a two-stage TJR and had at least two years of follow-up were included. Demographic characteristics, surgical variables, and outcomes were collected and analyzed from clinical and surgical data. Statistical analysis was performed using IBM SPSS Statistics, with statistical significance at p < 0.05. One hundred and fourteen patients (61 with hip SA, 53 with knee SA) were included in the study. The mean follow-up was 72.8 months. Postoperatively, both clinical and functional outcomes significantly improved, as indicated by the Hip Society Score (HHS) and Knee Society Score (KSS). The overall success rate of the two-stage protocol was 89.5%. Complications that did not require revision occurred in 21% of cases. The most identified pathogen was methicillin-sensitive Staphylococcus aureus (MSSA). Difficult-to-treat (DTT) infections and post-traumatic etiology were identified as predictors of treatment failure in patients undergoing two-stage TJR for hip and knee SA. Two-stage TJR in hip and knee SA demonstrated favorable clinical outcomes at mid-term follow-up. The procedure significantly improved functional scores and achieved a high success rate, while DTT infections and post-traumatic etiology were associated with a higher risk of treatment failure.

Musculoskeletal melioidosis in a 33-year-old farmer presenting with the right leg cellulitis: A case report from North India

Melioidosis, caused by Burkholderia pseudomallei, has been described as “the great mimicker” due to its varied clinical presentation. Musculoskeletal melioidosis is a rare presentation of this disease, and here we report a 33-year-old male, farmer from Madhya Pradesh, who presented with fever for 2 months and right leg swelling for 25 days. He was treated elsewhere as cellulitis and managed with intravenous antibiotics and fasciotomy. Magnetic resonance imaging knee and leg showed diffuse osteomyelitis of the upper tibia with similar tiny foci and sinus tract present. A diagnosis of the right knee septic arthritis with multifocal osteomyelitis was made. Focal pus culture grew pansensitive B. pseudomallei. He was started on Inj. Meropenem and oral cotrimoxazole tablet. He also underwent right tibial debridement, sequestrectomy, and saucerisation. He was discharged after initial therapy and has improved significantly on follow-up. This case highlights a very common clinical condition caused by a rather uncommon etiological agent and therefore renumerates the importance of insightful clinical suspicion with appropriate use of investigations and treatment options to prevent further morbidity and mortality.

Arthritis or an Adjacent Fascial Response? A Case Report of Combined Pyomyositis and Aseptic Arthritis

Pyomyositis, accompanied by aseptic arthritis, has been previously documented in several publications. However, none of the authors in the mentioned case reports offered a pathophysiological explanation for this unusual phenomenon or proposed a treatment protocol. We present a case of a healthy, 70‐year‐old male who was presented to the emergency department 4 days after tripping over a pile of wooden planks and getting stabbed by a nail to his thigh. The right thigh was swollen. Unproportional pain was produced by a light touch to the thigh. A laboratory test and a CT scan were obtained. The working diagnosis was pyomyositis of the thigh and septic arthritis of the ipsilateral knee. The patient underwent urgent debridement and irrigation of his right thigh. An arthroscopic knee lavage was performed as well. Intraoperative cultures from the thigh revealed the growth of Streptococcus pyogenes and Staphylococcus aureus. Cultures from synovial fluid were sterile; thus, septic arthritis was very unlikely. The source of the knee effusion might have been an aseptic inflammatory response due to the proximity of the thigh infection. Anatomically, the quadriceps muscle inserts on the patella, and its tendon fuses with the knee capsule, creating a direct fascial track from the thigh to the knee. The inflammatory response surrounding the infection may have followed this track, creating a domino effect, affecting adjacent capillaries within the joint capsule, and causing plasma leakage into the synovial space, leading to joint effusion. Our suggested treatment is addressing the primary infection with antibiotics and considering adding anti‐inflammatory therapy, given our suspicion that this process has an inflammatory component.

Editorial commentary: efficacy of taurolidine irrigation during arthroscopic debridement for bacterial septic knee arthritis

<i>Editorial commentary</i>: efficacy of taurolidine irrigation during arthroscopic debridement for bacterial septic knee arthritis

Trauma

The October 2023 Trauma Roundup360 looks at: Intramedullary nailing versus sliding hip screw in trochanteric fracture management: the INSITE randomized clinical trial; Five-year outcomes for patients with a displaced fracture of the distal tibia; Direct anterior versus anterolateral approach in hip joint hemiarthroplasty; Proximal humerus fractures: treat them all nonoperatively?; Tranexamic acid administration by prehospital personnel; Locked plating versus nailing for proximal tibia fractures: a multicentre randomized controlled trial; A retrospective review of the rate of septic knee arthritis after retrograde femoral nailing for traumatic femoral fractures at a single academic institution.

Septic Arthritis of the Knee in Children.

Septic arthritis of the knee is the most common form of septic arthritis in children and can lead to irreversible damage to the joint. Staphylococcus aureus is the primary pathogen associated with septic arthritis, although other causative pathogens may be isolate in children with specific risk factors. The diagnosis of knee septic arthritis is based on comprehensive evaluation, including the patient's medical history, physical examination, blood tests, and arthrocentesis. Empirical treatment typically involves anti-staphylococcal penicillin or a first-generation cephalosporin, although modifications may be made based on local resistance patterns and clinical culture data. Surgical debridement, either through open surgery or arthroscopy, involving extensive debridement of the joint, is effective in eliminating the infection. In most cases, additional surgical intervention is not necessary.

At the Crossroads: Bilateral Septic Knee Arthritis in Diabetic Patients – A Comprehensive Study and Future Perspectives

Septic arthritis of the knee is a potentially devastating acute joint condition, requiring prompt and accurate management to minimize long-term complications. This article looks at an exceptional case of bilateral septic arthritis of the knee in a 53-year-old patient with diabetes mellitus, who has no history of joint trauma. A thorough analysis of its clinical symptomatology, radiological results and laboratory tests. Direct examination of joint fluid is particularly notable, showing gram-negative bacilli, although microbial cultures remain negative despite repeated attempts. These results were compared with the existing literature on bilateral septic knee arthritis. Clinical implications are explored, including diagnostic challenges in diabetic patients, as well as treatment options and recommendations for future research. In conclusion, this article highlights the importance of effectively recognizing and managing rare cases of bilateral septic knee arthritis, taking into account patient specificities, such as diabetes. It provides useful information to clinicians and encourages further research in this complex area of rheumatology.

Arthroscopic versus open irrigation and debridement in native knee septic arthritis: A retrospective review

IntroductionNative knee septic arthritis is a rare condition with a potential for high morbidity if not promptly treated. Treatment involves surgical decompression of the affected joint along with systemic antibiotic therapy. The purpose of this study is to compare arthroscopic versus open irrigation and debridement for treatment of native knee septic arthritis. MethodsA retrospective review was conducted at a single academic institution of all patients treated for native knee septic arthritis from January 2007 until August 2018 utilizing ICD and CPT codes. Patient demographics, type of surgical procedure, need for reoperation, laboratory values, length of stay, and comorbidities were compared. ResultsA cohort of sixty-six patients who underwent 85 surgeries were included. Among these surgeries, 52 (61%) were arthroscopic while 33 (39%) were open arthrotomies, and 21% required more than one operation. While not statistically significant, the odds of reoperation was higher for those that underwent arthroscopic compared to open irrigation and debridement on univariable (OR = 4.05, p = .08) and multivariable analysis (OR = 4.39, p = .10). Additionally, patients were more likely to require a longer hospital stay if they initially underwent arthroscopic rather than open debridement (RR = 1.31, p = .02). ConclusionNative knee septic arthritis can be treated with a single surgery in the majority of cases. In our sample, there was an increased odds of reoperation in those treated arthroscopically compared to open, though this finding was not statistically significant. We found longer length of stay for patients undergoing arthroscopic rather than open irrigation and debridement – even after controlling for multiple operations, culture status, sex, age, and comorbidities.

Risk of repeated drainage in pediatric septic arthritis: patient or method?

How drainage of septic arthritis should be performed remains controversial. The aim of the present study was to compare arthrocentesis (Ac) using double intra-articular needle lavage to arthrotomy (At) as first-line drainage treatment for pediatric hip and knee septic arthritis. The secondary objective was to identify risk factors of second articular drainage. A retrospective review of medical records of children with knee and hip septic arthritis was conducted. Inclusion criteria were: children treated for septic arthritis between 2014 and 2020 with a positive culture of joint fluid. Clinical, biological, radiographical and ultrasound data were recorded at presentation and during follow-up. Patients were divided into 2 groups according to the type of drainage performed: Ac or At. 25 hips and 44 knees were included, 42 treated by Ac (15 hips, 27 knees) and 27 by At (10 hips, 17 knees). There is no significant difference between Ac and At regarding the need for repeated drainage and Ac nor At was reported as risk factor for repeated drainage. The presence of associated musculoskeletal infection (MSI) was a significant risk factor of repeated drainage [odds ratio = 11.8; 95% confidence interval = 1.2-114.2; P < 0.001]. Significantly more associated MSI ( P < 0.001), level I virulence germs ( P < 0.001) and positive blood culture (<0.001) were found in patients who underwent repeated drainage. There was no significant difference between Ac and At regarding rate of repeated drainage. The risk factors for repeated drainage were: associated with MSI, virulent germs and positive blood culture.

Risk Factors and Outcomes for Preoperative Stiffness Requiring Intervention Before Anterior Cruciate Ligament Reconstruction.

To date, there is a scarcity of literature related to the incidence of prolonged stiffness after an anterior cruciate ligament (ACL) tear that requires manipulation under anesthesia/lysis of adhesions (MUA/LOA) in the preoperative period before ACL reconstruction (ACLR) and how preoperative stiffness influences outcomes after ACLR. Preoperative stiffness requiring MUA/LOA would increase the risk for postoperative stiffness, postoperative complications, and the need for subsequent procedures after ACLR. Cohort study; Level of evidence, 3. The PearlDiver Research Program was used to identify patients who sustained an ACL tear and underwent ACLR using their respective International Classification of Diseases, 9th or 10th Revision, and Current Procedure Terminology (CPT) codes. Within this group, patients with preoperative stiffness were identified using the CPT codes for MUA or LOA. Significant risk factors for preoperative stiffness were identified through univariate and multivariate logistic regression analyses. Outcomes after ACLR were analyzed between patients with and without preoperative stiffness using multivariate logistic regression, controlling for age, sex, and Elixhauser Comorbidity Index. Between 2008 and 2018, 187,071 patients who underwent ACLR were identified. Of these patients, 241 (0.13%) underwent MUA/LOA before ACLR. Patients with preoperative stiffness began preoperative physical therapy significantly later than patients without stiffness (P = .0478) and had a delay in time to ACLR (P = .0003). Univariate logistic regression demonstrated that female sex, older age, anxiety/depression, obesity, and anticoagulation use were significant risk factors for preoperative stiffness (P < .05 for all). After multivariate regression, anticoagulation use was the only independent risk factor deemed significant (odds ratio, 6.69 [95% CI, 4.01-10.51]; P < .001). Patients with preoperative stiffness were at an increased risk of experiencing postoperative stiffness, deep vein thrombosis, pulmonary embolism, surgical-site infection, and septic knee arthritis after ACLR (P < .05 for all). Although the risk of preoperative stiffness requiring an MUA/LOA before ACLR is low, the study findings indicated that patients with preoperative stiffness were at increased risk for postoperative complications compared with patients with no stiffness before ACLR.

Deep learning-based assessment of knee septic arthritis using transformer features in sonographic modalities

PurposeSeptic arthritis is an infectious disease. Conventionally, the diagnosis of septic arthritis can only be based on the identification of causal pathogens taken from synovial fluid, synovium or blood samples. However, the cultures require several days for the isolation of pathogens. A rapid assessment performed through computer-aided diagnosis (CAD) would bring timely treatment. MethodsA total of 214 non-septic arthritis and 64 septic arthritis images generated by gray-scale (GS) and Power Doppler (PD) ultrasound modalities were collected for the experiment. A deep learning-based vision transformer (ViT) with pre-trained parameters were used for image feature extraction. The extracted features were then combined in machine learning classifiers with ten-fold cross validation in order to evaluate the abilities of septic arthritis classification. ResultsUsing a support vector machine, GS and PD features can achieve an accuracy rate of 86% and 91%, with the area under the receiver operating characteristic curves (AUCs) being 0.90 and 0.92, respectively. The best accuracy (92%) and best AUC (0.92) was obtained by combining both feature sets. ConclusionsThis is the first CAD system based on a deep learning approach for the diagnosis of septic arthritis as seen on knee ultrasound images. Using pre-trained ViT, both the accuracy and computation costs improved more than they had through convolutional neural networks. Additionally, automatically combining GS and PD generates a higher accuracy to better assist the physician's observations, thus providing a timely evaluation of septic arthritis.

Correlation of native knee joint septic arthritis and bacteremia: A retrospective study

Objectives: Septic arthritis is an orthopedic emergency, delayed treatment results in rapid, and irreversible joint destruction with significant morbidity and mortality. The correlation between the infectious organism(s) isolated from blood and synovial fluid remains unclear. Native joint septic arthritis (NJSA) is often secondary to bacteremia and other contiguous sources of infection. This investigation examined the correlation in infectious organisms between blood and synovial fluid in patients with NJSA and concurrent bacteremia. Methods: A retrospective chart review was performed on 712 NJSA cases at an urban, level-one trauma center. Patients diagnosed with septic knee arthritis through synovial fluid analysis with white blood cell count &gt;50,000 and/or positive culture from the knee joint on aspiration were included in the study. The organism identified on blood culture in the bacteremic patient was then correlated to the organism found on synovial fluid analysis. Results: We identified 104 patients at our institution with septic knees; 48 with bacteremia and 56 that did not have bacteremia. Of these patients with bacteremia, 34 patients (70.8%) had the same organism isolated in the knee and the blood. This correlation was statistically significant, with P = 0.003. Furthermore, patients with bacteremia underwent a mean of 1.85 ± 0.76 debridement procedures versus 1.21 ± 0.80 procedures in those without (P = 0.001). Conclusion: This study shows a correlation between the organism isolated from the knee and the blood in patients with NJSA in conjunction with bacteremia as well as a correlation between the bacteremic patient and the number of surgical interventions required per patient.

A retrospective review of the rate of septic knee arthritis after retrograde femoral nailing for traumatic femoral fractures at a single academic institution.

Retrograde intramedullary nailing of the femur is a popular treatment option for femoral shaft fractures. However, this requires accessing the intramedullary canal through the knee, posing a risk of intra-articular infection. The purpose of this study was to examine the rate of intra-articular infection of the knee after retrograde nailing of femoral shaft fractures. All patients who underwent retrograde intramedullary nailing for femoral shaft fractures between June 2004 and December 2017 at a level 1 trauma center were reviewed. Six months of follow-up or documented fracture union was required. Records were reviewed for documentation of septic arthritis of the ipsilateral knee during the follow-up period. A total of 294 fractures, including 217 closed and 77 open injuries, were included. Eighteen had an associated ipsilateral traumatic arthrotomy; 188 cases had an associated ipsilateral lower extremity fracture. No cases of septic arthritis were identified. There were no cases of septic arthritis in 294 fractures treated with retrograde intramedullary nailing. Retrograde nailing appears safe for risk of postoperative septic arthritis of the knee even in the face of open fractures and traumatic wounds.

Factors associated with subsequent surgery after septic arthritis of the knee in children.

Septic arthritis of the knee in children is a challenging problem. Surgical debridement is an established treatment, but there is a paucity of literature on long-term prognosis. To determine the rates and factors associated with return to surgery (RTS) and readmission after index surgical debridement for septic arthritis of the knee in children. This is a retrospective cohort study that utilizes data from the Healthcare Cost and Utilization Project (HCUP). We included patients between ages 0 to 18 years that underwent surgical debridement for septic arthritis of the knee between 2005 and 2017. Demographic data included age, gender, race, hospital type and insurance type. Clinical data including index admission length of stay (LOS) and Charlson Comorbidity Index (CCI) were available from the HCUP database. Descriptive statistics were used to summarize the data and univariate and multivariate analyses were performed. Nine-hundred thirty-two cases of pediatric septic knee were included. This cohort was 62.3% male, with mean age of 9.0 (± 6.1) years. Approximately 46% of patients were white and approximately half had Medicaid insurance. Thirty-six patients (3.6%) required RTS at a minimum of 2 year after index surgery, and 172 patients (18.5%) were readmitted at any point. The mean readmission LOS was 11.6(± 11.3) d. Higher CCI was associated with RTS (P = 0.041). There were no significant associations in age, gender, race, insurance type, or type of hospital to which patients presented. Multivariate analysis showed that both increased CCI (P = 0.008) and shorter LOS (P = 0.019) were predictive of RTS. Septic arthritis of the knee is an important condition in children. The CCI was associated with RTS at a minimum of 2 years after index procedure. No association was found with age, gender, race, insurance type, or hospital type. Shorter LOS and CCI were associated with RTS in multivariate analysis. Overall, risk of subsequent surgery and readmission after pediatric septic knee arthritis is low, and CCI and shorter LOS are predictive of RTS.

Hepatopathy in sickle cell disease with osteomyelitis: a challenging diagnosis: case report

‘Sickle hepatopathy’ is a condition which is seen in only 10% cases of sickle cell disease (SCD). Sickle hepatopathy could be due to acute sickle crisis, sequestration, cholangiopathy, severe intrahepatic cholestasis or as a result of chronic blood transfusion related infection and hemosiderosis. Differentiating the cause for hepatopathy in SCD is challenging. Hepatopathy manifestation can range from mild liver function test abnormality to life threatening fulminant hepatic failure. Hence, demanding prompt recognition and management. Here we reported a one such case of 13 year old male with progressing jaundice and bony pain with swelling of lower limbs was diagnosed as SCD with right proximal tibia sickle osteomyelitis and left knee septic arthritis with hepatopathy who was managed with supportive care and surgical intervention.