Treatment Of Septic Arthritis Research Articles

206. Teriparatide: An Unexpected Adjunct for the Treatment of a Longstanding Infected Elbow Prosthesis Prevented Arm Amputation

A 76-year-old woman with rheumatoid arthritis, osteoporosis and multiple comorbidities presented with septic left elbow prosthesis. Treatment included combination antibiotic therapy and removal of the prosthesis. Weeks later she was started on teriparatide. Her elbow symptoms resolved. In our experience, this is the first case in the literature reporting teriparatide efficacy in the treatment of septic arthritis.

Arthroscopic Treatment of Septic Arthritis of the Elbow in a 4-Year-Old Girl.

Pediatric septic arthritis is uncommon and has been traditionally treated by joint aspiration or open arthrotomy. There are some reports about arthroscopic surgery in pediatric septic arthritis of the knee, hip, and shoulder. However, there is no report for the case of elbow. We report a case of pediatric septic arthritis of elbow treated with arthroscopically with good clinical condition at 3-year follow-up. This paper is based on a report first published in Japanese (Tojo (2012)).

Treatment of septic arthritis and acute osteomyelitis

Acute hematogenous bone and joint infections, septic arthritis, and osteomyelitis with or without adjacent septic arthritis, are rare among children in a standard Western setting, but still potentially devastating diseases, as even deaths have been reported recently. Foir this reason, and in part due to historical reasons, the treatment has comprised of months-long courses of antibiotics, started intravenously for at least a week, and aggressive surgery. Recent prospective and randomized trials have shown that a 2-4-day parenteral course, completed orally to a total duration of 10-14 days for septic arthritis and of 3 weeks for osteomyelitis, heals the great majority of cases, provided large-enough doses of a well-absorbing antibiotic, and a four-times-daily (qid) regimen is used. Staphylococcus aureus - the most common causative agent in osteoarticular infections - is the primary target for treatment. For methicillin-susceptible strains, first-generation cephalosporins, clindamycin, and staphylococcal penicillins are first-line antibiotics of which clindamycin has retained activity even for most cases due to methicillin-resistant S.aureus. This said, instead of clindamycin, beta-lactam antibiotics are effective also against Kingella kingae. The role of surgery in uncomplicated cases is minor, even in cases of shoulder or hirp arthritis, as most children recover uneventfully with no greater intervention than diagnostic bone or joint aspiration. Routine arthrotomy seems unnecessary even in hip or shoulder arthritis. However, each patient needs an individual approach, and a deviation from the general treatment lines should be executed when the conditions so dictate.

Therapy of tarsal arthritis in cow

With mastitis and reproductive disorders, musculoskeletal diseases represent one of the most important problems in modern cattle production. In this paper we described the diagnostic procedure and the possibility of treatment of septic arthritis in cattle. After a successful general clinical examination, ultrasound diagnostics and arthrocenthesis of affected joint are done. After ultrasound examination and trail puncture of the joint are done, we conducted therapy which was consisting of local and systemic treatments. By conducted therapy there was a significant improvement in the health of the animal. The swelling is completely evaporated and lameness was less pronounced, and it is progressively reduced in the future.

Streptococcus dysgalactiae Subspecies Equisimilis; An Agent Rarely Encountered in the Etiology of Septic Arthritis

: Streptococcus dysgalactiae subspecies equisimilis is one of the pyogenic group C and G streptococcus, which may be found in the normal gastrointestinal and genitourinary flora of a healthy human. Many cases have been reported in literature; however, reports of septic arthritis due to this agent without predisposing factors are extremely rare. Diagnosis of this agent is possible in advanced laboratories. Appropriate treatment for septic arthritis caused this agent is made by parenteral antibiotherapy without debridement following accurate diagnosis.

Rapid in situ chondrocyte death induced by Staphylococcus aureus toxins in a bovine cartilage explant model of septic arthritis

To assess in situ chondrocyte viability following exposure to a laboratory strain and clinical isolates of Staphylococcus aureus. Bovine cartilage explants were cultured in the presence of S.aureus 8325-4 (laboratory strain), clinical S.aureus isolates or non-infected culture medium of pH values 7.4, 6.4 and 5.4. All clinical isolates were isolated from the joint aspirates of patients presenting with S.aureus-induced septic arthritis (SA). At designated time points, in situ chondrocyte viability was assessed within defined regions-of-interest in the axial and coronal plane following live- and dead-cell image acquisition using the fluorescent probes 5-chloromethylfluorescein diacetate (CMFDA) and propidium iodide (PI), respectively, and confocal laser-scanning microscopy (CLSM). Cartilage water content, following S.aureus 8325-4 exposure, was obtained by measuring cartilage wet and dry weights. S.aureus 8325-4 and clinical S.aureus isolates rapidly reduced in situ chondrocyte viability (>45% chondrocyte death at 40h). The increased acidity, observed during bacterial culture, had a minimal effect on chondrocyte viability. Chondrocyte death commenced within the superficial zone (SZ) and rapidly progressed to the deep zone (DZ). Simultaneous exposure of SZ and DZ chondrocytes to S.aureus 8325-4 toxins found SZ chondrocytes to be more susceptible to the toxins than DZ chondrocytes. Cartilage water content was not significantly altered compared to non-infected controls. Toxins released by S.aureus have a rapid and fatal action on in situ chondrocytes in this experimental model of SA. These data advocate the prompt and thorough removal of bacteria and their toxins during the treatment of SA.

Arthroscopic Treatment of Septic Arthritis of the Hip in a Child: A Case Report

Recommended treatment options for acute septic arthritis in children include repeated aspiration, open arthrotomy, and arthroscopic drainage. However, reports of arthroscopic treatment of septic arthritis of the hip in a child are rare. We experienced a case of arthroscopic management of acute septic arthritis of the right hip joint in a three-year-old child using a 30。 , 2.7 mm arthroscope for the ankle joint through manual traction without use of a traction table. The patient had complete range of motion in the right hip joint two weeks after surgery and recurrent infection was not observed at the final follow-up two years postoperatively.

Hip Arthroscopy in Children under the Age of Ten

Arthroscopic hip surgery has become an established diagnostic and therapeutic method for addressing different hip pathologies. This paper focuses on hip arthroscopy for treating hip disorders in children under the age of 10. Arthroscopic hip surgery was performed 30 times on 24 children to address various hip pathologies. Indications were septic arthritis, benign soft tissue tumors, traumatic and congenital hip dislocation, juvenile idiopathic arthritis and osteochondroma of the acetabulum. Diagnostic arthroscopy was technically feasible in all cases. All cases of septic arthritis were successful treated using arthroscopic lavage and antibiotics. In the miscellaneous cases (benign fibrous tumor, juvenile idiopathic arthritis, osteochondroma congenital hip dislocations and traumatic hip dislocation) 4 hips had additional open surgery including surgical dislocation with synovectomy, open reduction and stabilization of the fractured posterior rim of the acetabulum, acetabulopasty and open resection of an osteochondroma with acetabuloplasty. In conclusion arthroscopic hip surgery is an additional diagnostic and therapeutic method that is suitable for treating different hip pathologies in children under the age of 10. Primary treatment of septic arthritis can be done easy by hip arthroscopy. Using cannulated mini arthroscopic hip instruments (2.7 mm), the range of application can be expanded to include treatment of very young infants. Hip arthroscopy can reduce the need of open surgery but cannot replace bony procedures in hip surgery.

The Case Files

The Case Files

Arthroscopic approaches to the fetlock joint of adult cattle: A cadaver study

The objective of the present study was to describe the arthroscopic anatomy of the bovine fetlock joint using one palmar/plantar and three dorsal joint approaches. A comparative anatomic, ultrasonographic and arthroscopic study using 20 cadaveric feet from 13 non-lame adult dairy cows was performed. Arthroscopy was accomplished using a rigid arthroscope to view the synovial cavities with their synovial villi and parts of the following structures: the distal ends of the metacarpal/metatarsal III/IV bones with their trochleae and sagittal ridges, synovial grooves, the articular surfaces of the proximal sesamoid bones, the proximal aspects of the first phalanges, the lateral and medial collateral ligaments, the suspensory ligament and the interdigital ligaments as parts of the interosseus muscle, the cruciate sesamoidean ligaments, the communication site between the lateral and medial pouch in the palmar/plantar area, and dorsally the septum between the lateral and the medial pouch. The technique allowed a good overall view of most relevant structures in the sound cadaver joint. Further investigations are warranted to evaluate the diagnostic, therapeutic and prognostic applications of these techniques in the treatment of septic arthritis.

Septic Arthritis and Tuberculosis Arthritis

Septic arthritis is an important medical emergency, with high morbidity and mortality. We review the changing epidemiology of infectious arthritis, which incidence seems to be increasing due to several factors. We discuss various different risk factors for development of septic arthritis and examine host factors, bacterial proteins and enzymes described to be essential for the pathogenesis of septic arthritis. Diagnosis of disease should be making by an experienced clinician and it is almost based on clinical symptoms, a detailed history, a careful examination and test results. Treatment of septic arthritis should include prompt removal of purulent synovial fluid and needle aspiration. There is little evidence on which to base the choice and duration of antibiotic therapy, but treatment should be based on the presence of risk factors and the likelihood of the organism involved, patient’s age and results of Gram’s stain. Furthermore, we revised joint and bone infections due to tuberculosis and atypical mycobacteria, with a special mention of tuberculosis associated with anti-TNFα and biologic agents.

Graft retaining debridement in patients with septic arthritis after anterior cruciate ligament reconstruction.

Although septic arthritis following anterior cruciate ligament (ACL) reconstruction is a rare complication, it has a high morbidity deteriorating the clinical outcome. Current treatment options include long-term antibiotic therapy, open or arthroscopic surgical lavage, aspiration, continuous irrigation, graft preservation, and removal of graft and fixation materials with or without reimplantation. The aim of our study was to evaluate the results of long-term antibiotic treatment with arthroscopic debridement without graft and fixation materials removal in the treatment of septic arthritis following ACL reconstructions. Seven patients (6 male, 1 female; mean age: 29 years; range: 21 to 40 years) who had septic arthritis following ACL reconstruction at Uludag; University, Department of Orthopaedics and Traumatology were included in this study. Three of the patients were athletes, 1 was a heavyduty worker, 3 were light-medium-duty workers and 1 was an amateur sportsman. Long-term antibiotic therapy was used for 6 weeks. Rehabilitation was arranged according to the patients effusion, pain and general condition. Evaluations were made using clinical results, manual Lachman and pivot shift tests, and Tegner activity, Lysholm, and IKDC scores. Patients had a mean of 6 (range: 0 to 15) degrees of flexion loss and 3 (range: 0 to 5) degrees of extension loss. Manual Lachman test was near normal for all patients. Pivot shift was positive for 3 and negative for 4 patients. Preoperative and postoperative mean Tegner activity scores were 6 (range: 4 to 7) and 5 (range: 4 to 7), respectively. Preoperative and postoperative mean Lysholm scores were 73.2 (range: 67 to 79) and 74.1 (range: 79 to 89), respectively. Preoperative and postoperative mean IKDC scores were 78.0 (range: 70 to 100) and 80.0 (range: 70 to 100), respectively. Mean leg circumference across the quadriceps muscle was 91% (range: 88 to 93) of the contralateral leg. Single-leg longitudinal jumping length was 78% (range: 63 to 100) of the uninvolved leg. Single-leg horizontal jumping was 72% (range: 88 to 93) of the contralateral leg. Long-term antibiotic therapy and arthroscopic drainage without graft or fixation material removal is effective in patients of regular activity level. Although this procedure is equally successful for treating the infection in competitive athletes and heavy workers, it also results in slight performance loss. Further review is necessary to determine which treatment is suitable for which activity level.

Arthroscopic washout of the ankle for septic arthritis in a three-month-old boy

There is no report of athroscopic treatment for septic arthritis of the ankle in infants. We report a case of successful management of septic arthritis of the ankle in a three-month-old boy by arthroscopic washout. Arthroscopic washout may be a useful treatment for septic arthritis in young infants when performed early after onset.

Septic arthritis: what is the role for the rheumatologist?

Septic arthritis (SA) is a clinical emergency with considerable morbidity and mortality that can lead to rapid joint destruction and irreversible loss of function. The reported incidence varies from 2-5 cases per 100.000 individuals per year in the general populations to 70 cases per 100.000 individuals annually among patients with rheumatoid arthritis (RA). Predisposing factors are immunosuppressive and corticosteroids therapy and RA "itself". The expected decrease in incidence of SA was not seen over the last 20 years period but we can, on the contrary, expect an increase in the frequency of its appearance because of the population ageing, the increasingly prosthetic joint replacement, the ability of the bacteria to evade clearance by the host immune response and the rapidly growing number of patients with RA, ankylosing spondylitis and psoriatic arthritis treated with tumour necrosis factor alpha (TNF alpha) antagonists. Up to now there have been conflicting reports regarding joint infections in patients under anti-TNF therapy but according to data from Deutsch as well as the British register there might be an increase in the incidence of joint infections in anti-TNF treated patients. Microscopic analysis and culture of synovial fluid are fundamental diagnostic tools in the evaluation of possible joint sepsis. Sonographic guidance of arthrocentesis led to successful aspiration of difficult-to-access joints as shoulder and hip. There is controversy over which mode of drainage of septic synovial fluid should be employed but needle aspiration appear to be preferable to surgical treatment as an initial mode of treatment of SA. Rheumatologists should have a central role in the diagnosis and management of SA.

Septic arthritis in foals

Summary In the neonatal foal septic arthritis is an important cause of morbidity that may limit future athletic performance. This is often despite a good prognosis for resolution of joint infection. This article presents a review of the diagnosis and treatment of septic arthritis in foals less than 2 months of age, including an overview of our current understanding of inflammatory joint disease in the neonate. Management options are described, with emphasis on tailoring therapy to the individual foal based on accurate staging and monitoring of the disease process. Special considerations relevant to the immature animal are addressed.

What are we doing about septic arthritis? A survey of UK-based rheumatologists and orthopedic surgeons

This study aims to determine the current practices and beliefs of United Kingdom (UK)-based rheumatologists and orthopedic surgeons (OS) in managing septic arthritis (SA) and to determine awareness levels of national guidance. Two-hundred OS and 200 rheumatologists were sent a link to a web-based survey tool via email. Questions posed related to the management of SA, including the respondent's views on antibiotic therapy, joint drainage, which specialty should manage these cases, and also the clinician's evidence base. There were 354 functioning addresses with 182 responses (51%). One hundred fifty-one (77 OS, 74 rheumatologists) (43%) responses were complete and included for analysis. Eighty percent of rheumatologists and 82% of OS recommended 6-weeks total antibiotic therapy. Seventy-three percent in each group recommended 1-2 weeks intravenous therapy initially followed by oral continuation therapy. In patients at risk of methicillin-resistant Staphylococcus aureus (MRSA), 25% rheumatologists and 14% OS would ensure MRSA cover. Seventy-seven percent of rheumatologists and 66% of OS recommended surgical joint drainage; 22% and 27%, respectively, recommended repeated closed needle aspiration as their chosen method of joint drainage. Sixty-six percent of rheumatologists and 65% of OS believed OS should manage SA. Twenty-three percent of rheumatologists and 22% of OS quoted published guidance as their main evidence base in the treatment of SA. Only 24% of rheumatologists and 34% of OS quoted British Society of Rheumatology (BSR) guidance when asked if they were aware of any guidelines. Views of rheumatologists and OS are not that dissimilar in managing SA. Surprisingly, rheumatologists are more aggressive regarding the recommendation for surgical joint drainage. Within both groups, significant variation in management principles exists often discrepant to recommendations laid out by the BSR. There are poor awareness levels of the BSR guidelines.

A Comparison of Early Versus Late Conversion From Intravenous to Oral Therapy in the Treatment of Septic Arthritis

A Comparison of Early Versus Late Conversion From Intravenous to Oral Therapy in the Treatment of Septic Arthritis

Comparison of Arthroscopic and Open Treatment of Septic Arthritis of the Wrist: Surgical Technique

Comparison of Arthroscopic and Open Treatment of Septic Arthritis of the Wrist: Surgical Technique

Return to Sports Activity After Postoperative Septic Arthritis in ACL Reconstruction

Background: Septic arthritis after arthroscopic anterior cruciate ligament (ACL) reconstruction is a rare but potentially serious complication. Several different options have been proposed to treat this condition. Our study aims to report the clinical, radiological, and sports activity results using our original protocol based on outpatient irrigation of the knee as well as parenteral and oral antibiotics. Methods: From January 2001 to January 2009, 14 patients (all active in sports) were treated for postoperative septic arthritis of the knee after ACL reconstruction in our institute. The treatment protocol included outpatient irrigation of the knee and parenteral antibiotics, followed by oral antibiotics. Repetitive irrigation was performed if necessary. The average follow-up period for our series was 38 months (range, 8–54 months). Follow-up included International Knee Documentation Committee (IKDC) forms, radiographs, Tegner and Lysholm scores, and KT-1000™ arthrometric evaluation. Results: Treatment of infection was successful in all cases. At final examination, pivot shift score was negative in 12 of 14 patients, and was > 1 in 2 of 14 patients, whereas the Lachman item score was negative in all cases. The mean postoperative Tegner score was 7, and 12 of 14 patients returned to the same sport at the same level after surgery. The mean Lysholm score was 96. Using the IKDC score, 12 of 14 patients were graded as group A, and 2 of 14 patients were graded as group B. The mean postoperative manual maximum KT-1000™ side-to-side difference was 2.5 mm. No significant bone tunnel enlargement was found when evaluating the patients' radiographs. Conclusion: The treatment regimen previously described provides reliable results for this complication. There were no recurrences of septic arthritis or bone infection, and no further surgeries were required. The graft could be retained during treatment of septic arthritis. Almost all patients returned to the preoperative and preinfection sport at the same level.

Osteomyelitis in elderly patients

Older adults are predisposed to osteomyelitis either because of an increased incidence of associated disorders (e.g., peripheral vascular disease, diabetes mellitus, malnutrition and poor dentition) or because of surgical procedures that are frequently performed in the elderly population (e.g., dental extractions, open-heart surgery, and prosthetic joint replacement or osteosynthesis). Two types of haematogenous osteomyelitis that are seen in the elderly are vertebral and long bone osteomyelitis. The most common pathogen is Staphylococcus aureus. Osteomyelitis secondary to contiguous foci of infection can occur in older adults without vascular insufficiency (secondary to pressure ulcers) or with vascular insufficiency due to diabetes mellitus or peripheral vascular disease from atherosclerosis. Chronic osteomyelitis may be defined as osteomyelitis that has a duration of more than 6 weeks or that recurs or is not cured after the initial infection. Chronic osteomyelitis may be associated with certain surgical procedures (e.g., sternal osteomyelitis after open-heart surgery or implant-related infections after orthopaedic and traumatological procedures), poor dentition or dental extraction (mandibular osteomyelitis), and, more commonly, with systemic disorders (e.g., peripheral vascular disease and diabetes mellitus). Acute osteomyelitis can in some cases be cured with antimicrobial therapy alone but surgical management is often required and includes extensive debridement, obliteration of dead spaces, stabilisation, adequate soft tissue coverage, and restoration of an effective blood supply. Chronic osteomyelitis may be caused by S. aureus or coagulase negative staphylococci, but is often due to gram-negative organisms. Because of the presence of infected bone fragments without a blood supply (sequestra), cure with antibiotic therapy alone is rare, if ever, possible and adequate surgical debridement is the cornerstone of therapy. Bone repair and bone mineral density may be significantly retarded and may be corrected by eliminating risk factors, supplementing the diet with calcium, bisphosphonates, and/or vitamin D, and treating with testosterone and/or estrogen when deficient. Sodium fluoride treatment and anabolic steroids may be used as alternatives. Septic arthritis is a medical emergency, and prompt recognition and rapid and aggressive treatment are critical to ensuring a good prognosis. The treatment of septic arthritis includes appropriate antimicrobial therapy and joint drainage. Adverse effects of prescribed antibacterials occur more often in the elderly patient than in young adults. The physician can help to minimise the incidence of adverse effects and improve outcomes by being aware of the principles of clinical pharmacology, the characteristics of specific drugs, and the special physical, psychological and social needs of older patients, Figure ​Figure1,1, ​,2,2, ​,3,3, ​,44. Figure 1 Septic knee prosthesis. The arrow shows the bone loss, due to infection and loosening of the implant. Figure 2 X-ray after septic prosthesis removal and antibiotic-loaded spacer implant Figure 3 Total knee re-implantation after 3 months. Note the filling of the bone defect in medial aspect of the tibial plateau Figure 4 Control after 2 years