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

Davis, Caleb M; Zamora, Rodolfo

doi:10.1016/j.arth.2019.10.062

Cited by 18 publications

(17 citation statements)

References 13 publications

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“…Hip arthroscopy is considered a very effective method for examining and treating joint disorders, and its use is widely increasing [ 8 ] . Traditionally, open arthrotomy has been the most common surgical approach for septic arthritis of the hip joint [ 4 , 6 ]. However, although aggressive debridement can be performed, hip function decreases after open arthrotomy.…”

Section: Discussionmentioning

confidence: 99%

“…They described that the frequency of septic arthritis of the hip joint reached a mean of just over two cases per year, and almost half of them were under 15 years old. Repeated aspirations, open arthrotomy, and arthroscopic treatment have been reported as surgical treatments for hip septic arthritis [ 4 – 6 ]. Historically, open arthrotomy remains the gold standard for treating septic arthritis of the hip joint [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and safety of arthroscopic treatment for native acute septic arthritis of the hip joint in adult patients

Fukushima

Uekusa

Koyama

et al. 2021

BMC Musculoskelet Disord

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Background As septic arthritis is time-dependent and has a propensity for irreversible joint damage, early diagnosis and treatment are needed. Frequently, adult patients with septic arthritis cannot undergo invasive surgery because of comorbidities and a weakened immune system. Hip arthroscopic irrigation and debridement for native acute septic arthritis of the hip joint have been performed as the first choice of treatment for patients of all ages. This study aimed to assess the efficacy and safety of arthroscopic management for native acute septic arthritis of the hip joint in adult patients. Methods Five adult patients (mean age, 46.2 years; all male) were retrospectively reviewed. Immediately after diagnosis, all patients underwent hip arthroscopic irrigation, debridement with synovectomy, and drainage. Partial weight-bearing was permitted once the C-reactive protein level normalised to < 1.0 mg/dl. Preoperative comorbidities, bacterial culture results, surgical complications, duration of hospital stay, time-to-confirmed normalisation of the C-reactive protein level, and recurrence incidence were evaluated. Results All patients had comorbidities, and the cultured microorganisms differed among cases. There were no complications related to arthroscopic surgery. All patients achieved confirmed C-reactive protein normalisation within an average of 69.8 days, and there was no recurrence during the follow-up period (mean, 40.2 months; range, 16–60 months). Conclusion Arthroscopic management for native acute septic arthritis of the hip joint is a safe and effective procedure in adult patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of arthroscopic treatment for native acute septic arthritis of the hip joint in adult patients

Fukushima

Uekusa

Koyama

et al. 2021

BMC Musculoskelet Disord

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“…It also removes vascularized bone and tissue that may assist in eradication of the infection. As can be inferred from treatment of septic arthritis in the native knee, success without bone removal has already been demonstrated with open irrigation and debridement (I and D) alone, arthroscopic I and D, and even serial arthrocentesis [ 8 – 10 ]. Theoretically, the natural surfaces of the knee may be comparatively more resistant to persistent biofilms, and the remaining viable and vascular tissues may support increased local antibiotic delivery.…”

Section: Discussionmentioning

confidence: 99%

Modified Two-Stage Exchange for Periprosthetic Joint Infection in UKA

Yun

Qutami

Pasko

2020

Case Reports in Orthopedics

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Periprosthetic joint infection (PJI) is a rare complication following unicompartmental knee arthroplasty (UKA), and current management guidelines are still evolving. This report presents a novel surgical technique of resection arthroplasty with an articulated hemispacer as part of a 2-stage exchange protocol. A 66-year-old man developed a culture-negative PJI four months after a medial UKA. Rather than conventional full resection arthroplasty, the patient underwent partial resection with preservation of the lateral and patellofemoral compartments to maintain vascularized bone stock. An articulating hemispacer fashioned from the old implants after sterilization was reimplanted medially to preserve function during the course of antibiotic treatment. After successful eradication of infection, the patient underwent an uncomplicated conversion total knee replacement facilitated by prior preservation of bone stock. No stems or augments were needed. Therefore, a partial resection arthroplasty with an articulating hemispacer used in a 2-stage exchange protocol may be a reasonable option to eradicate infection and maintain function. In future cases of infected UKA, this technique warrants further consideration and investigation.

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“…Septic arthritis represents an orthopedic emergency which is tackled by surgical interventions along with high doses of intravenous antibiotics given immediately within the first 24 hours [ 7 , 155 , 156 ]. Phages can also be administrated intravenously during this emergency period in order to provide more effective control of the infection process and associated sepsis as demonstrated in past studies [ 122 , 157 – 160 ].…”

Section: Methodsmentioning

confidence: 99%

Novel therapeutic interventions towards improved management of septic arthritis

Wang

2021

BMC Musculoskelet Disord

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Septic arthritis (SA) represents a medical emergency that needs immediate diagnosis and urgent treatment. Despite aggressive treatment and rapid diagnosis of the causative agent, the mortality and lifelong disability, associated with septic arthritis remain high as close to 11%. Moreover, with the rise in drug resistance, the rates of failure of conventional antibiotic therapy have also increased. Among the etiological agents frequently isolated from cases of septic arthritis, Staphylococcus aureus emerges as a dominating pathogen, and to worsen, the rise in methicillin-resistant S. aureus (MRSA) isolates in bone and joint infections is worrisome. MRSA associated cases of septic arthritis exhibit higher mortality, longer hospital stay, and higher treatment failure with poorer clinical outcomes as compared to cases caused by the sensitive strain i.e methicillin-sensitive S. aureus (MSSA).In addition to this, equal or even greater damage is imposed by the exacerbated immune response mounted by the patient’s body in a futile attempt to eradicate the bacteria. The antibiotic therapy may not be sufficient enough to control the progression of damage to the joint involved thus, adding to higher mortality and disability rates despite the prompt and timely start of treatment. This situation implies that efforts and focus towards studying/understanding new strategies for improved management of sepsis arthritis is prudent and worth exploring.The review article aims to give a complete insight into the new therapeutic approaches studied by workers lately in this field. To the best of our knowledge studies highlighting the novel therapeutic strategies against septic arthritis are limited in the literature, although articles on pathogenic mechanism and choice of antibiotics for therapy, current treatment algorithms followed have been discussed by workers in the past. The present study presents and discusses the new alternative approaches, their mechanism of action, proof of concept, and work done so far towards their clinical success. This will surely help to enlighten the researchers with comprehensive knowledge of the new interventions that can be used as an adjunct therapy along with conventional treatment protocol for improved success rates.

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

Cited by 18 publications

References 13 publications

Efficacy and safety of arthroscopic treatment for native acute septic arthritis of the hip joint in adult patients

Efficacy and safety of arthroscopic treatment for native acute septic arthritis of the hip joint in adult patients

Modified Two-Stage Exchange for Periprosthetic Joint Infection in UKA

Novel therapeutic interventions towards improved management of septic arthritis

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