Medical Versus Surgical Approach to Initial Treatment in Septic Arthritis

A Single Spanish Center's 8-Year Experience

Bryan Josué Flores-Robles, MD; Mercedes Jiménez Palop, MD; Abel Alejandro Sanabria Sanchinel, MD; Robert Francis Andrus, MD; Ana Royuela Vicente, MD; Marta Isabel Sanz Pérez, MD; María Espinosa Malpartida, MD; Consuelo Ramos Giráldez, MD; Carolina Merino Argumanez, MD; Luis Fernando Villa Alcázar, MD; José Luis Andréu Sánchez, MD, PhD; Hildegarda Godoy Tundidor, MD; José Campos Esteban, MD; Jesús Sanz Sanz, MD; Carmen Barbadillo Mateos

Disclosures

J Clin Rheumatol. 2019;25(1):4-8. 

In This Article

Abstract and Introduction

Abstract

Objective: The aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis.

Methods: In this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016.

Results: A total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54–76 years], vs. 48 years [IQR, 30–60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28–49 days], vs. 29.5 days [IQR, 27–49] days), and mortality rate (3 in the medical group).

Conclusions: The results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases.

Introduction

Septic arthritis is an arthropathy caused by the invasion of microorganisms, (commonly bacteria) into the synovial membranes, resulting in purulent effusion within the joint capsule, by direct inoculation or secondary hematogenous dissemination, with the consequent destruction of the synovial membranes.[1,2] Clinical characteristics include pain, erythema, and swelling with reduced range of articular movement. The reported incidence is 7.8 cases per 100,000 persons per year, with a mortality rate of approximately 10%.[3] Delayed diagnosis and treatment may result in irreversible joint damage and permanent disability and/or death.[4] The standard therapeutic modality includes intravenous administration of broad-spectrum antibiotics and drainage of the affected joint by daily needle aspirations or by surgical procedures such as arthroscopy or arthrotomy. The selection of the type of drainage is generally based on the experience of the treating physician. Data that describe the efficacy of each type of intervention are based on small studies and systemic literature reviews, which show that an initial surgical approach is not superior to serial needle aspirations.[5–8]

The objective of the present study was to compare the functional results of patients diagnosed as having septic arthritis and treated with initial medical treatment (IMT) with those treated with initial surgical treatment (IST). Both groups received antibiotic therapy according to hospital protocol.

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