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Rodrigues TC, Taneja AK, Skaf A, Godoy IRB. Upper extremity infection: imaging features with focus on magnetic resonance imaging. Skeletal Radiol 2023:10.1007/s00256-023-04545-8. [PMID: 38097765 DOI: 10.1007/s00256-023-04545-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 11/01/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
Upper extremity infections are frequently seen, especially in individuals with weakened immune system, posttraumatic events, and after surgery procedures. If not properly treated, such conditions can lead to serious consequences, such as movement impairment, amputation, and even mortality. These infections have the potential to spread extensively from their initial site of entry, traversing interconnected spaces either intra or extra-compartmental. Understanding the relevant anatomy is crucial to assess location and stage of infection, since surgical intervention and intravenous antibiotics are usually required. In this article, the authors provide a comprehensive review of the imaging findings of upper extremity infection, focusing on magnetic resonance imaging (MRI). Furthermore, this article sheds light on the pivotal role of radiology in managing hand, elbow, and shoulder infections offering an overview of available treatment options. KEY FINDINGS: Various types of infections affecting the upper extremity will be discussed, including infectious tenosynovitis, deep space infections, septic arthritis, and osteomyelitis. Authors also highlight anatomical spaces, common pathogens, spread routes, and key radiological features of these conditions.
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Affiliation(s)
- Tatiane Cantarelli Rodrigues
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Atul Kumar Taneja
- Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Abdalla Skaf
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil
| | - Ivan Rodrigues Barros Godoy
- Department of Radiology, Hospital Do Coração (HCor), Rua Desembargador Eliseu Guilherme, 53, 7Th Floor. CEP, São Paulo, SP, 04004-030, Brazil.
- ALTA Diagnostic Center (DASA Group), São Paulo, Brazil.
- Department of Diagnostic Imaging, Universidade Federal de São Paulo - UNIFESP, São Paulo, SP, Brazil.
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Nasim O, Khalil A, Khan S, Kohli S, Pantelias C, Banoori F, Durrani A, Karim A, Moverley R. Microbiological Profile and Clinical Features of Septic Arthritis of the Shoulder: A 10-Year Cohort Single-Centre Study. Cureus 2023; 15:e51074. [PMID: 38269230 PMCID: PMC10807700 DOI: 10.7759/cureus.51074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Septic arthritis (SA) constitutes a pressing orthopedic emergency characterized by acute, non-traumatic joint pain. Timely diagnosis and intervention are imperative to avert complications such as chondrolysis and systemic sepsis. The etiology is predominantly hematogenous, necessitating an integrated approach involving surgical and microbiological modalities. Shoulder aspiration and microbiological analysis play pivotal roles in guiding treatment, especially when positive findings prompt more aggressive therapeutic strategies. This study aims to elucidate the nuanced clinical and epidemiological characteristics of septic arthritis in both native and prosthetic joints within a singular institutional cohort over a decade. Methods This retrospective case series analysis spanned a 10-year period, focusing on non-prosthetic shoulder joints from January 2012 to July 2021. In this timeframe, only 183 aspirations were performed and sent to the microbiology department for analysis, including cultures, microscopy, and antibiotic sensitivity tests for positive cultures. The study delved into the microbiological profile of infections, encompassing gram stain, culture positivity rates, identification of microorganisms, and antibiotic susceptibility patterns. Additionally, the incidence of primary joint infections with resistant strains, particularly methicillin-resistant Staphylococcus aureus (MRSA), was scrutinized. Statistical analysis utilized the SPSS program version 20.0 (IBM Inc., Armonk, New York), with a significance level set at 5%. The project, registered with the trust's clinical audit department (Reg #5372), adhered to the Declaration of Helsinki and good clinical practice guidelines. Data collection involved extracting non-identifiable patient modifiers from the laboratory database bank into Excel spreadsheets. Results The study included 183 patients, with 108 (59%) females and 75 (41%) males. The average age was 76.2±16.5 years. Among them, 138 (75.4%) reported pain, and 15 (8.2%) had a body temperature over 37.8°C. Lab results showed a mean white blood cell count of 11.6±4.5 and an average C-reactive protein level of 121.7±102.1. Leucocytosis (>11,000 WBC) was seen in 82 (44.8%) cases. Elevated C-reactive protein (CRP; >10 mg/dl) was found in 136 (74.3%) patients. Synovial fluid analysis revealed no crystals in 91.3% of cases. Microbial resistance analysis showed 19 strains resistant to co-trimoxazole and 11 to erythromycin. Among co-trimoxazole-resistant strains, 73.7% were Staphylococcus aureus, a statistically significant association (p<0.001). Conclusion The evolving sensitivity patterns of microbes in septic arthritis underscore the necessity to reassess empirical antibiotic therapy. Subsequent joint damage resulting from infection can result in substantial disability.
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Affiliation(s)
- Omer Nasim
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Aamir Khalil
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Salman Khan
- Surgery, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Suraj Kohli
- Trauma and Orthopedics, University Hospital Southampton NHS Foundation Trust, Southampton, GBR
| | - Charalampos Pantelias
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Fatima Banoori
- General Medicine, Quaid-e-Azam International Hospital, Islamabad, PAK
| | - Abdullah Durrani
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Arsallan Karim
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
| | - Robert Moverley
- Trauma and Orthopedics, University Hospitals Dorset NHS Foundation Trust, Poole, GBR
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Bois AJ, Gabig AM, Griffin LP, Rockwood CA, Brady CI, Dutta AK. The evaluation, classification, and management of septic arthritis of the shoulder: the comprehensive shoulder sepsis system. J Shoulder Elbow Surg 2023; 32:2453-2466. [PMID: 37331502 DOI: 10.1016/j.jse.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 04/30/2023] [Accepted: 05/06/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND Septic arthritis of the shoulder is distinctly challenging to diagnose and treat. Guidelines for appropriate workup and management are limited and do not account for the variations in clinical presentation. The purpose of this study was to present a comprehensive and anatomically based classification system and treatment algorithm for septic arthritis of the native shoulder joint. METHODS A multicenter, retrospective analysis of all patients treated surgically for septic arthritis of the native shoulder joint was performed at 2 tertiary care academic institutions. Preoperative magnetic resonance imaging and operative reports were used to classify patients as having 1 of 3 infection subtypes: type I, confined to the glenohumeral joint; type II, extra-articular extension; or type III, concomitant osteomyelitis. On the basis of these clinical groupings of patients, the comorbidities, types of surgical management, and outcomes were analyzed. RESULTS Sixty-five shoulders in 64 patients met the inclusion criteria for the study. Of these infected shoulders, 9.2% had type I infections, 47.7% had type II, and 43.1% had type III. Age and the time between symptom onset and diagnosis were the only significant risk factors for the development of a more severe infection. Fifty-seven percent of shoulder aspirates revealed cell counts below the standard surgical cutoff of 50,000 cells/mL. On average, each patient required 2.2 surgical débridements to eradicate the infection. Infections recurred in 8 shoulders (12.3%). Body mass index was the only risk factor for recurrence of infection. Of the 64 patients, 1 (1.6%) died acutely of sepsis and multiorgan system failure. CONCLUSION We propose a comprehensive system for the classification and management of spontaneous shoulder sepsis based on stage and anatomy. Preoperative magnetic resonance imaging can help determine the severity of disease and aid in surgical decision making. A systematic approach to septic arthritis of the shoulder as a unique entity from septic arthritis of other large peripheral joints may lead to more timely diagnosis and treatment and improve the overall prognosis.
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Affiliation(s)
- Aaron J Bois
- Section of Orthopaedic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Andrew M Gabig
- Joe R. and Teresa Lozano Long School of Medicine, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | | | - Charles A Rockwood
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Christina I Brady
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Anil K Dutta
- Department of Orthopedic Surgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
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Ota M, Urita A, Shibayama H, Iwasaki N. Glenohumeral joint preservation using continuous intramedullary perfusion of high-concentration antibiotics in a patient with septic shoulder arthritis and proximal humerus osteomyelitis: A case report. J Orthop Sci 2023; 28:1548-1551. [PMID: 34716064 DOI: 10.1016/j.jos.2021.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/12/2021] [Accepted: 09/16/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Mitsutoshi Ota
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan; Department of Orthopaedic Surgery, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Atsushi Urita
- Department of Orthopaedic Surgery, Dokkyo Medical University, Mibu, Japan.
| | - Hiroki Shibayama
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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Abdelmalek A, Haines S, Tadros BJ, Evans JT, Judge A. Re-operation rates of arthroscopic management versus arthrotomy in treatment of septic arthritis of native shoulder joint in adults. A systematic review and meta-analysis. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:2717-2727. [PMID: 36869912 DOI: 10.1007/s00590-023-03495-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
AIMS Previous studies have reported concern regarding high reoperation rates when septic arthritis of the native shoulder is treated arthroscopically, compared to open arthrotomy. We aimed to compare re-operation rate between the two strategies. PATIENTS AND METHODS The review was registered prospectively at PROSPERO, (CRD42021226518). We searched common databases and references lists (8 February 2021). The inclusion criteria included interventional or observational studies of adult patients with a confirmed diagnosis of native shoulder joint septic arthritis and had either arthroscopy or arthrotomy. The exclusion criteria included patients with periprosthetic or post-surgical infections, patients who had atypical infections, and studies that did not report re-operation rate. Cochrane Collaboration's tool for assessing risk of bias (ROBINS-I) was used. RESULTS Nine studies (retrospective cohort studies) were included that involved 5,643 patients (5,645 shoulders). Mean age ranged from 55.6 to 75.5 years, and follow-up time ranged from 1-41 months. Mean duration of symptoms prior to presentation ranged from 8.3-23.3 days. Metanalysis observed a higher re-operation rate for reinfection at any time point following initial arthroscopy in comparison to arthrotomy, odds ratio 2.61 (95% confidence interval 1.04, 6.56). There was marked heterogeneity (I2 = 78.8%) among studies including surgical techniques and missing data. CONCLUSION This metanalysis observed a higher reoperation rate in arthroscopy in comparison to arthrotomy for the treatment of native shoulder septic arthritis in adults. The quality of the included evidence is low and the heterogeneity among included studies is marked. Higher quality evidence is still needed that address limitations of previous studies.
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Affiliation(s)
- Amir Abdelmalek
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom.
| | - Samuel Haines
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Baha John Tadros
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Jonathan T Evans
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
| | - Andrew Judge
- Musculoskeletal Research Unit, Learning and Research Building, Level 1, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
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Straub J, Lingitz MT, Apprich S, Staats K, Windhager R, Böhler C. Early postoperative laboratory parameters are predictive of initial treatment failure in acute septic arthritis of the knee and shoulder joint. Sci Rep 2023; 13:8192. [PMID: 37210581 DOI: 10.1038/s41598-023-35384-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/17/2023] [Indexed: 05/22/2023] Open
Abstract
Septic arthritis is an orthopedic emergency potentially causing irreversible joint damage. However, the predictive value of potential risk factors such as early postoperative laboratory parameters remains uncertain. We investigated risk factors for initial surgical treatment failure using data from 249 patients (194 knees, 55 shoulders) treated for acute septic arthritis between 2003 and 2018. Necessity for further surgical intervention was defined as primary outcome. Demographic data, medical history, initial and postoperative laboratory parameters, Charlson Comorbidity Index (CCI), and Kellgren and Lawrence classification were collected. Two scoring systems were developed as tools for failure risk estimation after initial surgical irrigation and debridement. More than one intervention was necessary in 26.1% of cases. Treatment failure occurred significantly more often for those with longer symptom duration (p = 0.003), higher CCI grades (p = 0.027), Kellgren-Lawrence grade IV (p = 0.013), shoulder arthroscopy (p = 0.010), positive bacterial culture results (p < 0.001), slow postoperative CRP decline until day three (p = 0.032) and five (p = 0.015), reduced WBC-decline (p = 0.008), and lower hemoglobin (p < 0.001). Scores for third and fifth postoperative day achieved AUCs of 0.80 and 0.85, respectively. This study identified risk factors for treatment failure in patients with septic arthritis, suggesting that early postoperative laboratory parameters can guide further treatment.
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Affiliation(s)
- Jennifer Straub
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Marie-Therese Lingitz
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Sebastian Apprich
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Kevin Staats
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Christoph Böhler
- Department of Orthopaedics and Trauma Surgery, Division of Orthopaedics, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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7
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Nahy E, Velasquez Garcia A. Interposition Arthroplasty for Chronic Proximal Humerus Osteomyelitis: A Case Report. JBJS Case Connect 2023; 13:01709767-202303000-00015. [PMID: 36821390 DOI: 10.2106/jbjs.cc.22.00557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
CASE Two years after a right shoulder arthroscopic procedure, a 49-year-old woman presented with significant dysfunction and pain to our orthopaedic department. Laboratory and imaging evaluation demonstrated chronic glenohumeral osteomyelitis with irreparable damage to the humeral articular surface. A 2-stage soft-tissue shoulder interposition arthroplasty was performed to rebalance the joint. Long-term follow-up revealed functional results with pain control and no reinfection. CONCLUSION For patients at high risk of reinfection or unable to undergo prosthetic joint implantation, this approach may be considered a functional alternative to salvage procedures.
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Affiliation(s)
- Emilio Nahy
- Department of Orthopedic Surgery, Hospital Dr. Miguel Pérez Carreño, Caracas, Venezuela
| | - Ausberto Velasquez Garcia
- Department of Orthopedic Surgery, Clinica Universidad de los Andes, Santiago, Chile.,Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Salazar LM, Gutierrez-Naranjo JM, Meza C, Gabig A, Bois AJ, Brady CI, Dutta AK. Joint aspiration and serum markers - do they matter in the diagnosis of native shoulder sepsis? A systematic review. BMC Musculoskelet Disord 2022; 23:470. [PMID: 35590311 PMCID: PMC9118805 DOI: 10.1186/s12891-022-05385-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/29/2022] [Indexed: 11/21/2022] Open
Abstract
Background Septic arthritis of the native shoulder is traditionally diagnosed with the same strategies as knee or hip septic arthritis. However, septic arthritis of the shoulder is frequently a missed or delayed diagnosis. Reliance on aspiration and serum markers has been called into question recently. The purpose of this study was to conduct a systematic review investigating the value of joint aspiration and serum markers in the diagnosis of native shoulder joint sepsis. Methods PubMed/MEDLINE, Scopus, and the Cochrane Library were used in the systematic literature search from January 1, 1960, through January 23, 2021. The primary outcome was to report on the synovial white cell count of patients with native shoulder sepsis. Descriptive statistics using percentages, means, and intraclass correlation coefficient (ICC) values were used to summarize the results. Results Thirty-one studies, including 25 case series, one case-control, and five cohort studies with a total of 7434 native shoulder joints, were included. There was no standardized approach to diagnosing septic arthritis of the shoulder. Only 10 studies (32%) reported on synovial white cell count with the majority yielding aspiration counts greater than 50,000 cells/mm3, although one study was as low as 30,000 cells/mm3. Conclusions The diagnosis of native shoulder joint sepsis lacks uniformity. Methods used to evaluate shoulder sepsis are heterogeneous and may lead to delays or misdiagnosis with devastating sequelae. Synovial white cell count is underutilized and may also present with a lower value than expected, which is likely related to the time interval between symptom onset and diagnosis.
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Affiliation(s)
- Luis M Salazar
- UT Health San Antonio, Long School of Medicine, San Antonio, TX, USA.
| | - Jose M Gutierrez-Naranjo
- UT Health San Antonio, Department of Orthopaedics, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229-3900, USA
| | - Clarissa Meza
- UT Health San Antonio, Long School of Medicine, San Antonio, TX, USA
| | - Andrew Gabig
- UT Health San Antonio, Long School of Medicine, San Antonio, TX, USA
| | - Aaron J Bois
- University of Calgary, Sport Medicine Centre, Calgary, AB, Canada
| | - Christina I Brady
- UT Health San Antonio, Department of Orthopaedics, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229-3900, USA
| | - Anil K Dutta
- UT Health San Antonio, Department of Orthopaedics, Floyd Curl Dr, MC 7774, San Antonio, TX, 78229-3900, USA
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Choi MH, Shin WC, Bae H, Park C, Moon NH, Kang SW. Factors affecting the occurrence of osseous lesions in septic shoulder arthritis and the recurrence rate after arthroscopic surgery. J Shoulder Elbow Surg 2022; 31:26-34. [PMID: 34174449 DOI: 10.1016/j.jse.2021.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 05/07/2021] [Accepted: 05/16/2021] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS The purpose of this study was to determine the incidence of osseous lesions and the recurrence rate after arthroscopic surgery in shoulder septic arthritis patients and evaluate the influencing factors. MATERIALS AND METHODS We retrospectively reviewed 44 patients who underwent arthroscopic surgery for septic arthritis of the shoulder between January 2012 and September 2019. The average age of the patients was 65.57 ± 14.2 years, and 56.8% were female patients. The minimum follow-up period was 12 months (average, 32.8 ± 14.2 months; range, 12-72 months). We assessed variables including sex, age, underlying diseases, duration from symptom onset to magnetic resonance imaging (MRI), duration from symptom onset to surgery, radiologic results (radiography and MRI), history of injection therapy, and postoperative infection. The incidence of osseous lesions and the recurrence rate were calculated according to independent variables. In addition, multivariate logistic regression was performed to identify the risk factors for osseous lesions and recurrent infection after adjustment for other variables. RESULTS Twenty-one patients had an osseous lesion on MRI, and 12 patients had evidence of bone erosion on radiographs. In univariate analyses, significant (P < .05) risk factors for the presence of osseous lesions were female sex, lower C-reactive protein level, and longer duration from symptom onset to MRI. The overall infection recurrence rate was 22.7% (10 of 44 patients). Culture results and the duration from symptom onset to surgery were significant risk factors for recurrent infection (P < .05). As the duration from symptom onset to MRI increased by 1 day, the probability of osseous lesions increased 1.31-fold (95% confidence interval, 1.08- to 1.59-fold; P = .007), and this probability was significantly higher after correction for other risk factors. CONCLUSIONS To reduce the severity of septic shoulder infection, timely diagnosis and treatment are essential. Even if osseous lesions are present, good results can be obtained if meticulous débridement is performed through arthroscopic surgery. However, functional and radiologic long-term follow-up studies are needed in patients with osseous lesions.
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Affiliation(s)
- Min Hyeok Choi
- Department of Preventive, and Occupational & Environmental Medicine, Medical College, Pusan National University Yangsan Hospital, Pusan National University, Yangsan, Repulic of Korea; Office of Public Healthcare Service, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Won Chul Shin
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Hyuk Bae
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Chankue Park
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Nam Hoon Moon
- Department of Orthopedics, Pusan National University Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea
| | - Suk-Woong Kang
- Department of Orthopaedic Surgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
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Abstract
Joint empyema, also known as septic arthritis, is a severe disease associated with considerable morbidity and mortality. Failing to initiate immediate treatment can result in irreversible joint destruction within a short time. The knee joint is most frequently involved, followed by the shoulder and hip joints. Small joints are rarely affected. Typical risk factors include immunosuppression, renal insufficiency, diabetes mellitus and previous joint interventions. An early targeted diagnostic work-up and initiation of therapeutic steps is crucial to avoid irreversible joint destruction. Joint aspiration for diagnostic purposes is essential and should be performed immediately when a septic arthritis is suspected. An important differential diagnosis is metabolic arthritis (gout and chondrocalcinosis), which typically presents in a similar way. A differentiation from septic arthritis is important as metabolic arthritis requires a completely different treatment. After confirming the diagnosis, treatment consisting of a surgical procedure combined with antibiotics is initiated. In most cases an arthroscopic intervention is sufficient. In severe cases the arthroscopy needs to be repeated. An arthrotomy must be carried out only rarely. A pre-emptive antibiotic treatment is initially administered and is later adjusted according to the resistogram. This article gives an overview on the pathophysiology, diagnostics and general management of joint empyema.
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Affiliation(s)
- Julian Brand
- Abteilung für Unfallchirurgie, Landesklinikum Horn, Spitalgasse 10, 3580, Horn, Österreich.
| | - Thomas Neubauer
- Abteilung für Unfallchirurgie, Landesklinikum Horn, Spitalgasse 10, 3580, Horn, Österreich
| | - Mohamed Omar
- Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Maranya SO, Mutiso VM. Bilateral glenohumeral septic arthritis secondary to mastitis with subsequent avascular necrosis: A case report. Int J Surg Case Rep 2021; 88:106502. [PMID: 34666252 PMCID: PMC8602743 DOI: 10.1016/j.ijscr.2021.106502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/09/2021] [Accepted: 10/09/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction and importance Septic arthritis is an orthopaedic emergency. Only 3% of septic arthritis patients present with glenohumeral involvement. Polyarticular disease with shoulder involvement constitutes 1% of this group. There is currently no documented case of bilateral glenohumeral septic arthritis with avascular necrosis secondary to mastitis. Case presentation We present a case of a 38-year-old African woman with bilateral glenohumeral septic arthritis after management for mastitis of the left breast. She had left, then right shoulder pain, fever, and reduced range of motion, with multiple arthroscopic washouts and antibiotic therapy instituted at various hospitals by various specialists, leading to the resolution of active infection. The patient developed bilateral humeral head avascular necrosis with complete collapse as evidenced on plain radiography 4 months later, and underwent hemiarthroplasty of the right shoulder. Biopsy at operation showed no active bone infection, and inflammatory markers were not elevated. She had reduced discomfort for the following 2 years but developed increasing pain on lifting and reduced range of motion. The moderate symptoms in her left shoulder managed non-operatively had remained unchanged. There were no elevated inflammatory markers 2-years post arthroplasty. Clinical discussion This case presents an uncommon scenario of bilateral septic arthritis secondary to mastitis, with rapid progression to avascular necrosis in an individual with no classical risk factors for avascular necrosis, despite appropriate antibiotic treatment and surgical interventions. Advanced collapse necessitated hemiarthroplasty of the dominant right side. Conclusion This case highlights the need for close radiographic follow-up in atypical presentations of septic arthritis and the dilemmas in managing advanced bilateral avascular necrosis with arthroplasty in a young patient. Septic arthritis is an orthopaedic emergency. Mortality rates for septic arthritis range from 4 to 42% in monoarticular disease and up to 50% in polyarticular involvement. Only 3% of septic arthritis cases are glenohumeral, with 1% being polyarticular. Humeral head avascular necrosis secondary to septic arthritis is rare.
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Affiliation(s)
- Samora Onsare Maranya
- Department of Orthopaedic Surgery, University of Nairobi, PO Box 19676-00202, Kenyatta National Hospital, Nairobi, Kenya.
| | - Vincent Muoki Mutiso
- Department of Orthopaedic Surgery, University of Nairobi, PO Box 19676-00202, Kenyatta National Hospital, Nairobi, Kenya; Division of Orthopaedics, Kenyatta National Hospital, Nairobi, Kenya.
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12
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Takahashi R, Kajita Y, Harada Y, Iwahori Y, Deie M. Factors affecting the outcome of septic arthritis of the shoulder joint with arthroscopic management. J Orthop Sci 2021; 26:381-384. [PMID: 32723522 DOI: 10.1016/j.jos.2020.04.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/21/2020] [Accepted: 04/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Good results have been reported with arthroscopic therapy of septic arthritis of the shoulder; however, few studies have focused on the risk factors for failure of arthroscopic surgery. The purpose of this study was to identify the risk factors affecting the recurrence or death post-surgery in cases of septic arthritis of the shoulder. METHODS We retrospectively assessed the records of patients who underwent surgical treatment for septic arthritis of the shoulder between 2009 and 2019. Patients were divided into 2 groups based on complete recovery, recurrence, or death after a single arthroscopic surgery: the eradicated group and the recurred/death group. To identify risk factors for the failure of arthroscopic surgery for septic arthritis of the shoulder, the following parameters were considered: age, sex, presentation of a rotator cuff tear, the arthroscopic staging of the infection, diabetes mellitus, the causative organism, preoperative white blood cell count, and C-reactive protein level in blood. We compared two groups with respect to the presence of potential risk factors. RESULTS This study included 22 patients with a mean age of 67.9 years. Septic arthritis of the shoulder was eradicated completely with a single arthroscopic surgery in 17 patients (77.3%). However, failure of the surgery resulting in recurrence or death was observed in 5 patients (22.7%). No significant differences were observed in other parameters between the two groups except for the causative organism. Methicillin-resistant Staphylococcus aureus was found in 1 patient (5.9%) in the eradicated group. On the other hand, Methicillin-resistant S. aureus was found in 3 patients (60%) in the recurred/death group (p = 0.024). CONCLUSION Most patients with septic arthritis of the shoulder are effectively treated with a single arthroscopic surgery. This study suggests that Methicillin-resistant S. aureus as the causative organism may be the most important prognostic factor in these cases.
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Affiliation(s)
- Ryosuke Takahashi
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan.
| | - Yukihiro Kajita
- Department of Orthopaedic Surgery, Ichinomiya Nishi Hospital, Japan; Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | - Yohei Harada
- Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | - Yusuke Iwahori
- Department of Orthopaedic Surgery, Aichi Medical University, Japan.
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Japan.
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Dbeis A, Sanderson B, Rahman S, Jazayeri R. Bilateral shoulder septic arthritis due to suspected bacterial endocarditis: A case report. Int J Surg Case Rep 2021; 80:105624. [PMID: 33640641 PMCID: PMC7921498 DOI: 10.1016/j.ijscr.2021.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 11/30/2022] Open
Abstract
Septic arthritis of the shoulder is rare but potentially devastating. Bilateral shoulder septic arthritis is even more rare of a diagnosis. Patients can often present with unimpressive physical examination findings, so it is of utmost importance to keep septic arthritis as a differential diagnosis. It is paramount that patients be promptly treated with surgical intervention and the appropriate antibiotic therapy for preservation of life and limb, regardless of the chronicity or severity of the septic joint.
Introduction Septic arthritis is an orthopedic emergency that requires rapid diagnosis and treatment. It is typically caused by occult bacteremia which allows bacteria to seed the joint or local invasion of a soft tissue infection. Most cases of septic arthritis are caused by gram-positive bacteria, with the most common culprit being Staphylococcus Aureus. The reason septic arthritis is an orthopedic emergency is because of rapid destruction to cartilage. The mechanism of injury to cartilage is two-fold: bacterial enzymes are directly toxic to joint cartilage, and buildup of exudate can tamponade blood flow and cause anoxic injury. Typically, the knee is the most commonly involved joint. This is followed by the hip, ankle, elbow, wrist, and shoulder in descending order of occurrence. Polyarticular disease makes up a small percentage of these cases and if present, it is usually asymmetric and will involve at least one knee joint. Presentation of case Bilateral joint septic arthritis is relatively rare. We present an uncommon case of atraumatic bilateral septic shoulders in an elderly man with a history of heart disease and insidious bilateral shoulder pain after golfing 18 holes. This presentation is unique not only in its rarity but also in its impact on our understanding of septic arthritis in the setting of medical comorbidities and a relatively unimpressive presentation. With a recent golfing day just prior to presentation, differential diagnoses other than septic arthritis included deltoid/rotator cuff muscle strain, acute on chronic rotator cuff tendinosis, acute on chronic rotator cuff tearing, acute flare up of osteoarthritis, rheumatoid arthritis, or crystalline arthropathy. With elevated inflammatory markers and an equivocal physical examination, our patient underwent advanced imaging via MRI and subsequent bilateral glenohumeral joint diagnostic aspirations that were consistent with septic arthritis due to his complaining of contralateral shoulder pain shortly after his admission. Immediately after said diagnosis was made, the patient was taken back for emergent bilateral open irrigation and debridement, as septic arthritis is an orthopedic emergency, and went on to recover appropriately on culture-directed intravenous antibiotic therapy. Discussion/conclusion This case report is impactful with regard to clinical practice for multiple reasons. First and foremost it is a cautionary tale for all clinicians with regard to the level of suspicion one must have for polyarticular septic arthritis in the setting of the multiply painful patient. Second, it demonstrates the utility of advanced imaging in the equivocal patient. Lastly, it underscores the importance of prompt diagnosis and treatment, validating the existing algorithm for septic arthritis.
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Affiliation(s)
- Ammer Dbeis
- Graduate Medical Education, Orthopaedic Surgery Residency Program, Community Memorial Health System, Ventura, CA, USA.
| | - Brent Sanderson
- Graduate Medical Education, Orthopaedic Surgery Residency Program, Community Memorial Health System, Ventura, CA, USA
| | - Shawn Rahman
- University of North Texas Health Science Center, Fort Worth, TX, USA
| | - Reza Jazayeri
- Graduate Medical Education, Orthopaedic Surgery Residency Program, Community Memorial Health System, Ventura, CA, USA
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Voss A, Pfeifer CG, Kerschbaum M, Rupp M, Angele P, Alt V. Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts. Knee Surg Sports Traumatol Arthrosc 2021; 29:3149-3158. [PMID: 33755737 PMCID: PMC8458194 DOI: 10.1007/s00167-021-06525-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/26/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Septic arthritis is a significant complication following arthroscopic surgery, with an estimated overall incidence of less than 1%. Despite the low incidence, an appropriate diagnostic and therapeutic pathway is required to avoid serious long-term consequences, eradicate the infection, and ensure good treatment outcomes. The aim of this current review article is to summarize evidence-based literature regarding diagnostic and therapeutic options of post-operative septic arthritis after arthroscopy. METHODS Through a literature review, up-to-date treatment algorithms and therapies have been identified. Additionally, a supportive new algorithm is proposed for diagnosis and treatment of suspected septic arthritis following arthroscopic intervention. RESULTS A major challenge in diagnostics is the differentiation of the post-operative status between a non-infected hyperinflammatory joint versus septic arthritis, due to clinical symptoms, (e.g., rubor, calor, or tumor) can appear identical. Therefore, joint puncture for microbiological evaluation, especially for fast leukocyte cell-count diagnostics, is advocated. A cell count of more than 20.000 leukocyte/µl with more than 70% of polymorphonuclear cells is the generally accepted threshold for septic arthritis. CONCLUSION The therapy is based on arthroscopic or open surgical debridement for synovectomy and irrigation of the joint, in combination with an adequate antibiotic therapy for 6-12 weeks. Removal of indwelling hardware, such as interference screws for ACL repair or anchors for rotator cuff repair, is recommended in chronic cases. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Andreas Voss
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany.
- Sporthopaedicum, Regensburg, Straubing, Germany.
| | - Christian G Pfeifer
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Maximilian Kerschbaum
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Markus Rupp
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Peter Angele
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
- Sporthopaedicum, Regensburg, Straubing, Germany
| | - Volker Alt
- Department of Trauma Surgery, University Medical Center Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
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Clinical Results after Arthroscopic Treatment of Septic Shoulder with Proximal Bone Involvement. Indian J Orthop 2020; 55:167-175. [PMID: 34113425 PMCID: PMC8149767 DOI: 10.1007/s43465-020-00095-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 03/20/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND If osteomyelitis is confined to the proximal humerus, arthroscopic debridement with multiple punctures at the infected bone might be sufficient to eradicate the septic shoulder with bone involvement. MATERIALS AND METHODS From 2005 to 2017, 15 patients received arthroscopic debridement with multiple punctures. We included patients with septic shoulder arthritis with proximal bone involvement and excluded patients with glenohumeral joint destruction or extension of bone involvement to the diaphysis of the humerus. We performed multiple punctures for drainage of proximal humerus after complete arthroscopic debridement of septic soft tissue. Infection laboratory studies and postoperative magnetic resonance image were evaluated. For clinical outcome measurements, range of motion, pain visual analog scale, functional visual analog scale, American shoulder elbow surgeon scores, constant scores, and simple shoulder test were evaluated. RESULTS There were 11 males and 4 females with a mean age of 53 years (range 28-73 years). Mean follow-up was 32 months (range 12-115 months). There was no reinfection case. The postoperative C-reactive protein levels were normalized in all. The postoperative magnetic resonance image showed no bony involvement of the proximal humerus in all patients except one patient. The clinical scores and range of motion were significantly improved postoperatively. Six patients underwent secondary surgery for rotator cuff tear at a mean time period of 25 months (range 4-104 months) from the index period. CONCLUSION Septic shoulder with proximal bone involvement can be successfully treated with arthroscopic debridement with multiple punctures. LEVEL OF EVIDENCE Level IV, treatment study.
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Joo YB, Lee WY, Shin HD, Kim KC, Kim YK. Risk factors for failure of eradicating infection in a single arthroscopic surgical procedure for septic arthritis of the adult native shoulder with a focus on the volume of irrigation. J Shoulder Elbow Surg 2020; 29:497-501. [PMID: 31542323 DOI: 10.1016/j.jse.2019.07.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/02/2019] [Accepted: 07/08/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Septic arthritis of a native joint is relatively rare but is still a challenging and important orthopedic emergency. Most previous reports have focused on the clinical outcomes rather than the risk factors for failure in arthroscopic surgery. METHODS We retrospectively reviewed the records of patients with septic monoarthritis of the shoulder who underwent arthroscopic irrigation and débridement between January 2007 and January 2019. All patients were divided into 2 groups according to recurrence after a single arthroscopic surgical procedure: eradicated group or recurred group. To identify risk factors affecting the recurrence of septic arthritis of the shoulder after arthroscopic surgery, the following parameters were considered: age; sex; involved side; presentation of rotator cuff tear; volume of irrigation; bacterial organism involved; preoperative erythrocyte sedimentation rate, C-reactive protein level, and white blood cell count in blood and joint fluid; diabetes mellitus; and hypertension. We compared the eradicated and recurred groups regarding the presence of potential risk factors. RESULTS The study included 97 patients with a mean age of 61 years. Septic arthritis of the shoulder was eradicated completely with a single arthroscopic surgical procedure in 85 patients. However, a second arthroscopic surgical procedure was necessary in 12 patients (12.4%) because of infection recurrence. No significant differences were found between groups except in the volume of irrigation (P < .001). CONCLUSIONS Most patients with septic arthritis (87.6%) of native shoulders were effectively treated with a single arthroscopic irrigation and débridement. The amount of irrigation may be the most important factor for preventing the need for additional surgical management.
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Affiliation(s)
- Yong-Bum Joo
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Woo-Yong Lee
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea.
| | - Hyun Dae Shin
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
| | - Kyung Cheon Kim
- Department of Orthopedic Surgery, Shoulder Center, TanTan Hospital, Daejeon, Republic of Korea
| | - Yun-Ki Kim
- Department of Orthopedic Surgery, Chungnam National University School of Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea
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Lee DK, Rhee SM, Jeong HY, Ro K, Jeon YS, Rhee YG. Treatment of acute shoulder infection: can osseous lesion be a rudder in guideline for determining the method of débridement? J Shoulder Elbow Surg 2019; 28:2317-2325. [PMID: 31377005 DOI: 10.1016/j.jse.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/30/2019] [Accepted: 05/06/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. METHODS We retrospectively reviewed 57 patients who underwent arthroscopic or open débridement for acute shoulder infection between 2001 and 2015. Arthroscopic débridement was performed in 27 patients, and open débridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). RESULTS The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P < .05). CONCLUSIONS When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic débridement was above 75%. Therefore, if preoperative MRI showed erosions, open débridement is more likely to be appropriate than arthroscopic débridement.
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Affiliation(s)
- Dong Ki Lee
- Department of Orthopaedic Surgery, Narsha Hospital, Busan, Republic of Korea
| | - Sung-Min Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Ho Yeon Jeong
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kyunghan Ro
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yoon Sang Jeon
- Department of Orthopaedic Surgery, College of Medicine, Inha University, Incheon, Republic of Korea
| | - Yong Girl Rhee
- Shoulder & Elbow Clinic, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
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Goetti P, Gallusser N, Antoniadis A, Wernly D, Vauclair F, Borens O. Advanced septic arthritis of the shoulder treated by a two-stage arthroplasty. World J Orthop 2019; 10:356-363. [PMID: 31754606 PMCID: PMC6854056 DOI: 10.5312/wjo.v10.i10.356] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/03/2019] [Accepted: 09/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The usual treatment of septic shoulder arthritis consists of arthroscopic or open lavage and debridement. However, in patients with advanced osteoarthritic changes and/or massive rotator cuff tendon tears, infection eradication can be challenging to achieve and the functional outcome is often not satisfying even after successful infection eradication. In such cases a two-stage approach with initial resection of the native infected articular surfaces, implantation of a cement spacer before final treatment with a total shoulder arthroplasty in a second stage is gaining popularity in recent years with the data in literature however being still limited.
AIM To evaluate the results of a short interval two-stage arthroplasty approach for septic arthritis with concomitant advanced degenerative changes of the shoulder joint.
METHODS We retrospectively included five consecutive patients over a five-year period and evaluated the therapeutic management and the clinical outcome assessed by disability of the arm, shoulder and hand (DASH) score and subjective shoulder value (SSV). All procedures were performed through a deltopectoral approach and consisted in a debridement and synovectomy, articular surface resection and insertion of a custom made antibiotic enriched cement spacer. Shoulder arthroplasty was performed in a second stage.
RESULTS Mean age was 61 years (range, 47-70 years). Four patients had previous surgeries ahead of the septic arthritis. All patients had a surgical debridement ahead of the index procedure. Mean follow-up was 13 mo (range, 6-24 mo). Persistent microbiological infection was confirmed in all five cases at the time of the first stage of the procedure. The shoulder arthroplasties were performed 6 to 12 wk after insertion of the antibiotic-loaded spacer. There were two hemi and three reverse shoulder arthroplasties. Infection was successfully eradicated in all patients. The clinical outcome was satisfactory with a mean DASH score and SSV of 18.4 points and 70% respectively.
CONCLUSION Short interval two-stage approach for septic shoulder arthritis is an effective treatment option. It should nonetheless be reserved for selected patients with advanced disease in which lavage and debridement have failed.
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Affiliation(s)
- Patrick Goetti
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Nicolas Gallusser
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Alexander Antoniadis
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Diane Wernly
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Frédéric Vauclair
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
| | - Olivier Borens
- Department of orthopedic surgery and traumatology, Lausanne University Hospital and University of Lausanne, Lausanne 1010, Switzerland
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Shoulder Joint Infections with Negative Culture Results: Clinical Characteristics and Treatment Outcomes. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3756939. [PMID: 30891455 PMCID: PMC6390271 DOI: 10.1155/2019/3756939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 12/26/2018] [Accepted: 01/29/2019] [Indexed: 11/17/2022]
Abstract
Background The incidence of septic arthritis of the shoulder joint is increasing as the population ages. The prevalence of shoulder infection is also increasing because of the growing use of arthroscopy and expansion of procedures in the shoulder. However, cultures do not always identify all microorganisms, even in symptomatic patients. The incidence of negative cultures ranges from 0% to 25%. Few studies have reported clinical features and treatment outcomes of culture-negative shoulder infections. This cohort study addresses culture-negative shoulder joint infections in nonarthroplasty patients. This study aimed to compare clinical characteristics and treatment outcomes of patients with culture-negative results to those with culture-positive results. Our hypothesis was that culture-negative infections would have more favorable outcomes than culture-positive infections. Methods We retrospectively reviewed data of 36 patients (17 culture-negative and 19 culture-positive) with shoulder infections between June 2004 and March 2015. The minimum follow-up duration was 1.2 years (mean, 5 ± 3.8 years; range, 1.2-11 years). We assessed preoperative demographic data and characteristics, laboratory markers, imaging and functional scores, intraoperative findings, and postoperative findings of both groups. Results Culture-negative patients (17/36, 47.2%) had a significantly lower occurrence of repeated surgical debridement (culture-negative vs. culture-positive: 1.2 ± 0.4 vs. 2.4 ± 1.7, p = 0.002) without osteomyelitis. In the multiple logistic regression analysis, the presence of osteomyelitis [odds ratio (OR) = 9.7, 95% confidence interval (CI): 1.0-91.8, p=0.04)] and the number of surgical debridements (OR = 5.3, 95% CI: 1.3-21.6, p=0.02) were significantly associated with culture-positive infections. Conclusions Culture-negative infections without osteomyelitis are less severe than culture-positive infections. Culture-negative infections can be controlled more easily and are not necessarily a negative prognostic factor for shoulder joint infections.
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Besnard M, Babusiaux D, Garaud P, Rosset P, Bernard L, Le Nail LR, Berhouet J. Impact of setting up a bone and joint infection referral center on arthroscopic treatment of septic arthritis of the knee and shoulder: Retrospective study. Orthop Traumatol Surg Res 2018; 104:1265-1269. [PMID: 30341032 DOI: 10.1016/j.otsr.2018.08.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 08/02/2018] [Accepted: 08/23/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Referral Centers for Bone and Joint Infection (BJI) were set up to optimize BJI management thanks to multidisciplinary teamwork. The main aim of the present study was to assess the impact of setting up the Western France Bone and Joint Infection Referral Center on arthroscopic treatment of septic arthritis of the shoulder and knee. The secondary aim was to identify other risk factors for failure of this treatment. The null hypothesis was that there was no difference between the "success group" and the "failure group". MATERIAL AND METHODS This single-center retrospective study included 52 patients treated for septic arthritis between January 1, 2000 and December 31, 2013 by arthroscopic joint lavage associated to at least 4 weeks' antibiotic therapy. Exclusion criteria comprised: retrospective diagnosis of rheumatoid arthritis after negative bacteriological analysis, early cessation of antibiotic treatment, and follow-up less than 4 weeks. Failure was defined as non-healing after first-line treatment. The primary endpoint was date of treatment compared to the launch date of the Center in the first quarter of 2010. The influence of pre- and intraoperative criteria related to patient, treatment and microorganism was assessed. RESULTS At follow-up, 17 patients (32.9%) showed failure of first-line treatment and 5 (9.6%) were non-healed at end of treatment, whatever the re-intervention. The failure rate significantly decreased after setting up the Center, from 42.9% to 11.8% (p=0.03). In the failure group, 70.6% of patients showed immunosuppression, versus 37.2% in the success group (p=0.01). Neither time to surgery (p=1), type of microorganism, or performance of antiseptic lavage (p=0.25) or synovectomy (p=0.62) influenced outcome. CONCLUSION Multidisciplinary management of septic arthritis improved treatment success. LEVEL OF EVIDENCE III, Retrospective comparative study.
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Affiliation(s)
- Marion Besnard
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France.
| | - Damien Babusiaux
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
| | - Pascal Garaud
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France
| | - Philippe Rosset
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
| | - Louis Bernard
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Service de médecine interne et maladies infectieuses, centre hospitalier universitaire de Tours, boulevard Tonnellé, 37044 Tours cedex 09, France
| | - Louis-Romé Le Nail
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
| | - Julien Berhouet
- Université François-Rabelais de Tours, PRES Centre-Val de Loire Université, Tours, France; Services d'orthopédie 1 & 2, centre hospitalier universitaire de Tours, avenue de la République, 37044 Tours cedex 09, France; Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
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- Société orthopédique de L'Ouest, 18, rue de Bellinière, 49800 Trélazé, France
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Assunção JH, Noffs GG, Malavolta EA, Gracitelli MEC, Lima ALM, Ferreira Neto AA. Septic arthritis of the shoulder and elbow: one decade of epidemiological analysis at a tertiary referral hospital. Rev Bras Ortop 2018; 53:707-713. [PMID: 30377604 PMCID: PMC6204575 DOI: 10.1016/j.rboe.2017.08.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/15/2017] [Indexed: 11/21/2022] Open
Abstract
Objective To describe the clinical and epidemiological characteristics of patients with septic arthritis of the shoulder or elbow and to evaluate prognostic factors for complications during treatment. Methods A retrospective case series was studied with patients treated between 2004 and 2014. The patients’ clinical and epidemiological characteristics were collected. The clinical and orthopedic complications were identified and possible prognostic factors were evaluated. Results Twenty-seven patients were analyzed, 17 with septic arthritis of the shoulder and ten of the elbow. Median age was 46 years (IQR, 24.5; 61). Previous joint disease was observed in nine patients (33%). At least one clinical comorbidity was observed in 23 patients (85%). Staphylococcus aureus was identified in 14 cases (52%). Fourteen patients (52%) had at least one clinical complication and five patients died (19%). Nine patients (33%) had some type of orthopedic complication. The time between onset of symptoms and surgical treatment was longer in patients with orthopedic complications (p = 0.020). Regarding the development of clinical complications, leukocytosis on hospital admission time (p = 0.021) and the presence of clinical morbidities (p = 0.041) were predictive factors. Conclusions Septic arthritis of the shoulder and elbow primarily affects individuals who are immunocompromised and/or have clinical comorbidities. S. aureus is the most common pathogen in Brazil. Leukocytosis at hospital admission and the presence of clinical comorbidities are factors associated with the presence of clinical complications. Longer time between onset of symptoms and surgical treatment was correlated with orthopedic complications.
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Affiliation(s)
- Jorge Henrique Assunção
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Guilherme Guelfi Noffs
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Eduardo Angeli Malavolta
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | - Ana Lucia Munhoz Lima
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Arnaldo Amado Ferreira Neto
- Instituto de Ortopedia e Traumatologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
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Artrite séptica do ombro e do cotovelo: análise epidemiológica de uma década em um hospital terciário. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2017.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Arthroscopic Management of Septic Arthritis of the Native Shoulder: A Systematic Review. Arthroscopy 2018; 34:625-646.e1. [PMID: 29096980 DOI: 10.1016/j.arthro.2017.07.038] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 05/29/2017] [Accepted: 07/23/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate arthroscopic management of native shoulder joint septic arthritis-specifically, indications, patient outcomes, and complications. METHODS PubMed, MEDLINE, and Embase were used to search the literature, and data abstraction was performed independently and in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) checklist guided reporting and data abstraction. The quality of all included studies was assessed with the Methodological Index for Non-randomized Studies (MINORS) criteria. The results are presented in a narrative summary fashion using descriptive statistics including means, proportions, ranges, κ values, and intraclass correlation coefficient values. RESULTS Overall, 27 studies (19 case reports and 8 case series) were identified, including 115 patients (121 shoulders). The mean follow-up period was 29.1 months (range, 1-199 months). The indications for shoulder arthroscopy owing to infection included pain; limited range of motion; swelling, erythema, and tenderness; fever; elevated leukocyte count, erythrocyte sedimentation rate, and/or C-reactive protein level; synovial aspirate findings; and/or imaging findings. Overall, 46 patients (40%) achieved infection eradication and functional improvement after a single arthroscopic procedure. However, 43 patients (37%) had ongoing symptoms or complications, including 32 (30%) who required revision arthroscopic procedures, 7 (6%) who underwent open arthrotomy for septic arthritis management, 2 (2%) in whom avascular necrosis of the humeral head developed, 1 (1%) in whom adhesive capsulitis developed, and 1 (1%) in whom an irregular profile of the humeral epiphysis developed on plain radiographs. CONCLUSIONS Arthroscopic management of native shoulder septic arthritis can yield alleviation of pain and a return to full range of motion, daily activities, and sports. However, there is a high reoperation rate, which may correlate with poor patient prognostic factors. This systematic review did not show the superiority of either arthroscopic surgery or open arthrotomy for the management of shoulder septic arthritis. LEVEL OF EVIDENCE Level IV, systematic review of Level IV studies.
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Jung HJ, Song JH, Kekatpure AL, Adikrishna A, Hong HP, Lee WJ, Chun JM, Jeon IH. The use of continuous negative pressure after open debridement for septic arthritis of the shoulder. Bone Joint J 2017; 98-B:660-5. [PMID: 27143738 DOI: 10.1302/0301-620x.98b5.36720] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 11/11/2015] [Indexed: 12/17/2022]
Abstract
AIMS The treatment of septic arthritis of the shoulder is challenging. The infection frequently recurs and the clinical outcome can be very poor. We aimed to review the outcomes following the use of continuous negative pressure after open debridement with a large diameter drain in patients with septic arthritis of the shoulder. PATIENTS AND METHODS A total of 68 consecutive patients with septic arthritis of the shoulder underwent arthrotomy, irrigation and debridement. A small diameter suction drain was placed in the glenohumeral joint and a large diameter drain was placed in the subacromial space with continuous negative pressure of 15 cm H2O. All patients received a standardised protocol of antibiotics for a mean of 5.1 weeks (two to 11.1). RESULTS Negative pressure was maintained for a mean of 24 days (14 to 32). A total of 67 patients (98.5%) were cured without further treatment being required. At a mean follow-up of 14 months (three to 72), the mean forward flexion was 123° (80° to 140°) and the mean external rotation was 28°(10° to 40°) in those with a rotator cuff tear, and 125° (85° to 145°) and 35° (15° to 45°) in those without a rotator cuff tear. CONCLUSION Continuous negative pressure, following open arthrotomy, irrigation and debridement, was effective in treating septic arthritis of the shoulder. The rate of recurrence was significantly lower than with conventional treatment involving arthroscopic or open debridement reported in the literature. Functional outcomes, even in patients with rotator cuff tears, were excellent. TAKE HOME MESSAGE Continuous negative pressure is effective in treating septic arthritis of the shoulder. Cite this article: Bone Joint J 2016;98-B:660-5.
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Affiliation(s)
- H J Jung
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - J H Song
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - A L Kekatpure
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - A Adikrishna
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - H P Hong
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - W J Lee
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - J M Chun
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
| | - I H Jeon
- University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea
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Cho CH, Oh GM. Prognostic Factors Affecting the Clinical Outcome of Septic Arthritis of the Shoulder. J Hand Surg Asian Pac Vol 2016; 21:339-44. [DOI: 10.1142/s2424835516500314] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: The objective of this study was to determine prognostic factors affecting the clinical outcome of septic arthritis of the shoulder. Methods: We retrospectively reviewed 34 shoulders from 32 patients, two of which had bilateral involvement. Arthroscopic (22 shoulders) or open surgery (12 shoulders) was performed by a single surgeon. The mean follow-up period was 32.4 ± 17.0 months. Clinical outcomes according to the University of California at Los Angeles (UCLA) score, American Shoulder and Elbow Surgeons (ASES) score, and Subjective Shoulder Value (SSV) were assessed at the final follow-up period. Various factors were included for statistical analysis. Results: The mean UCLA, ASES scores, and SSV were 28.9 ± 7.2, 81.3 ± 21.0, 79.7 ± 2.5%, respectively. Positive culture was observed in only 13 shoulders (38.2%) and the most common organism was Staphylococcus aureus (seven shoulders). Five shoulders (14.7%) required two or three operations. Age and comorbidity were negatively correlated with the UCLA, ASES score, and/or SSV (p < 0.05). There was no correlation between clinical outcome and various parameters, including gender, location of lesion, history of previous steroid injection, interval between onset of symptoms and surgical intervention, bacterial organisms, operative method, and presence of rotator cuff tear and reoperation (p > 0.05). Conclusions: Both arthroscopic and open surgery for septic shoulders showed satisfactory clinical outcomes. Old age and comorbidity were poor prognostic factors of clinical outcomes after treatment.
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Affiliation(s)
- Chul-Hyun Cho
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
| | - Geon-Myeong Oh
- Pain Research Center, Department of Orthopedic Surgery, Dongsan Medical Center, School of Medicine, Keimyung University, Daegu, Korea
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Sobreira D, Souza ND, Almeida JID, Pochini ADC, Andreoli CV, Ejnisman B. Septic arthritis and arthropathy of the rotator cuff: remember this association. Rev Bras Ortop 2016; 51:444-8. [PMID: 27517024 PMCID: PMC4974163 DOI: 10.1016/j.rboe.2015.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 09/25/2015] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To describe occurrences of septic glenohumeral arthritis among patients with arthropathy of the rotator cuff, and to highlight the importance of correct diagnosis and surgical procedures. METHODOLOGY Eight surgical drains were installed in seven patients with glenohumeral pyoarthritis. All the patients presented arthropathy of the rotator cuff (four males and three females). Six patients presented pyoarthritis in the dominant shoulder. The age range was from 53 to 93 years (mean: 74 years). The mean duration of the symptoms before the surgical lavage was six weeks. Six patients underwent treatment consisting of a combination of arthroscopic irrigation and debridement, and one patient was treated by means of open arthrotomy. All the patients received systemic antibiotic therapy in accordance with their bacterial sensitivity. RESULTS All seven patients achieved satisfactory results, taking into consideration especially the improvement of pain and the patients' satisfaction. The functional assessment was performed using the University of California Los Angeles (UCLA) scale. Only one patient needed to go through another arthroscopic procedure. Staphylococcus aureus was isolated from four cultures and Escherichia coli from one culture. There were two situations in which the patients used empirical antibiotic therapy and the cultures showed negative results. Among the associated procedures, tenotomy of the biceps was performed in four cases, resection of the lateral third of the clavicle due to osteomyelitis in one case and arthrotomy of the knee in one case. CONCLUSION Surgical treatment was effective in the cases of arthritis associated with arthropathy of the rotator cuff. In patients with arthropathy of the rotator cuff and subclinically altered laboratory signs, the possibility of pyoarthritis should always be suspected.
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Affiliation(s)
- Danilo Sobreira
- Universidade Federal de São Paulo, Escola Paulista de Medicina, Departamento de Ortopedia e Traumatologia, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil
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Sobreira D, de Souza N, Almeida JID, Pochini ADC, Andreoli CV, Ejnisman B. Artrite séptica e artropatia do manguito rotador: lembrar‐se dessa associação. Rev Bras Ortop 2016. [DOI: 10.1016/j.rbo.2015.09.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Bull D, Tai Kie A, Hanusch B, Kulkarni R, Rees J, Rangan A. Is there sufficient evidence to support intervention to manage shoulder arthritis? Shoulder Elbow 2016; 8:77-89. [PMID: 27583004 PMCID: PMC4950461 DOI: 10.1177/1758573215622385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 10/28/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND We explore the nature, extent and validity of research studies concerning the management of shoulder arthritis to identify whether current management recommendations are adequate. METHODS A full electronic search for relevant studies published between 2002 and 2012 was performed. The search focused on level 1 and level 2 studies. Full texts of selected articles were retrieved and assessed for quality against validated criteria. RESULTS Four hundred and eleven studies were identified on the initial search and screened. Sixteen studies were selected for inclusion in the review. The studies identified were unable to provide a clear indication of best intervention for shoulder arthritis. The inclusion of a range of shoulder pathologies in some studies and the diversity in outcome measures used made it difficult for systematic reviews to effectively pool data. Better outcomes have been shown with total shoulder replacement over hemiarthroplasty for shoulder osteoarthritis; however, primary studies were often of limited quality. Sparse evidence is available for all other interventions, regardless of whether operative or non-operative. CONCLUSIONS The present review highlights the need for standardization of outcome assessment following treatment of shoulder arthritis. More rigorous and robust primary studies are needed to guide clinical practice on the best interventions for arthritis of the shoulder.
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Affiliation(s)
- Damian Bull
- James Cook University Hospital, Marton Road, Middlesborough, UK,Damian Bull, James Cook University Hospital, Marton Road, Middlesborough TS4 3BW, UK. Tel: +44 7793573567.
| | - Andrew Tai Kie
- James Cook University Hospital, Marton Road, Middlesborough, UK
| | - Birgit Hanusch
- James Cook University Hospital, Marton Road, Middlesborough, UK
| | | | - Jonathan Rees
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, UK
| | - Amar Rangan
- James Cook University Hospital, Marton Road, Middlesborough, UK
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Hotonu SA, Khan S, Jeavons R. Bilateral shoulder septic arthritis in a fit and well 47-year-old man. BMJ Case Rep 2015; 2015:bcr-2015-211406. [PMID: 26590186 DOI: 10.1136/bcr-2015-211406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Bilateral septic arthritis of the shoulder is uncommon in the immunocompetent patient with no previous risk factors for joint infection, and is thus easily missed. Septic arthritis is associated with significant rates of morbidity and mortality. Early diagnosis and management is the key to a favourable outcome; septic arthritis should be considered as a differential diagnosis in the unwell patient presenting with shoulder pain and reduced range of joint movement. We present a case of a 47-year-old previously fit and well man with bilateral shoulder septic arthritis. We will also review the current literature on management and long-term outcomes of patients with septic arthritis of the glenohumeral joint.
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Affiliation(s)
- Sesi Ayodele Hotonu
- Department of Trauma and Orthopaedics, North Tees and Hartlepool NHS Foundation Trust, Stockton-On-Tees, Cleveland, UK
| | - Shoaib Khan
- Department of Trauma and Orthopaedics, North Tees and Hartlepool NHS Foundation Trust, Stockton-On-Tees, Cleveland, UK
| | - Richard Jeavons
- Department of Trauma and Orthopaedics, North Tees and Hartlepool NHS Foundation Trust, Stockton-On-Tees, Cleveland, UK
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Garofalo R, Flanagin B, Cesari E, Vinci E, Conti M, Castagna A. Destructive septic arthritis of shoulder in adults. Musculoskelet Surg 2014; 98 Suppl 1:35-9. [PMID: 24659194 DOI: 10.1007/s12306-014-0317-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/12/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND Late sequelae of septic arthritis of the glenohumeral joint are very rare and represent a potentially devastating condition that can result in irreversible changes at the level of joint and surrounding soft tissues. MATERIALS AND METHODS Between January 2001 and December 2010, ten patients were treated at our institution for late sequelae of septic arthritis of the shoulder. There were eight men and two women with a mean age of 67.9 years (range 62-74 years). Eight of ten patients had previously received three or more intra-articular or subacromial injections. Surgical treatment consisted of open joint debridement, humeral head resection and implantation of an antibiotic spacer followed by a 6-8-week course of intravenous antibiotics. RESULTS White blood cell count, C-reactive protein and erythrocyte sedimentation rate normalized between 6 and 8 weeks postoperatively in all patients. No recurrent infection was observed in any patient. Postoperatively, the mean Constant score was 37 (range 28-46) and mean DASH score was 54 (range 40-69), demonstrating a very limited function in these patients. There was a trend toward improved outcome scores in patients who underwent early surgical debridement. Five patients underwent delayed reconstruction with a reverse shoulder prosthesis, and at minimum 1-year follow-up, the mean Constant score was 56 (range 47-69) and mean DASH score was 33 (31-38). CONCLUSIONS Antibiotic spacers are able to deliver antibiotics locally to the infected tissue while reducing the dead space and stabilizing the glenohumeral joint. An early, aggressive management of the infection is essential to maximize clinical outcomes and avoid either significant destruction or ankylosis of the shoulder joint.
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Affiliation(s)
- R Garofalo
- Shoulder Service Hospital F. Miulli, Acquaviva delle fonti, BA, Italy. .,, Via Padova 13, 70029, Santeramo in Colle, BA, Italy.
| | - B Flanagin
- Shoulder Center, Baylor University Medical Center, Dallas, TX, USA
| | - E Cesari
- Shoulder Unit, Humanitas Institute, IRCCS, Milan, Italy
| | - E Vinci
- Shoulder Unit, Humanitas Institute, IRCCS, Milan, Italy
| | - M Conti
- Shoulder Unit, Humanitas Institute, IRCCS, Milan, Italy
| | - A Castagna
- Shoulder Unit, Humanitas Institute, IRCCS, Milan, Italy
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Ibrahim A, Sarhane KA, Atiyeh BS. Salvage of shoulder joint through simplification of wound management. J Wound Care 2013; 22:S16-9. [DOI: 10.12968/jowc.2013.22.sup10.s16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- A.E. Ibrahim
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - K. A. Sarhane
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - B. S. Atiyeh
- Department of Surgery, Division of Plastic, Reconstructive and Aesthetic Surgery, American University of Beirut Medical Center, Beirut, Lebanon
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Abstract
The role of magnetic resonance imaging in evaluating shoulder arthropathies is evolving. This article reviews 4 of the major arthropathies: septic arthritis, rheumatoid arthritis, calcium pyrophosphate dihydrate (CPPD) deposition disease, and hydroxyapatite disease (HAD), with special attention to their magnetic resonance imaging features. Comfort with identifying these entities allows appropriate and prompt treatment, which is critical for joint preservation in the case of infection, for maximal therapeutic efficacy of disease-modifying drugs in the case of rheumatoid arthritis, and for expediting symptomatic relief in the cases of CPPD deposition disease and HAD.
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Verhelst L, Stuyck J, Bellemans J, Debeer P. Resection arthroplasty of the shoulder as a salvage procedure for deep shoulder infection: does the use of a cement spacer improve outcome? J Shoulder Elbow Surg 2011; 20:1224-33. [PMID: 21600789 DOI: 10.1016/j.jse.2011.02.003] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 02/09/2011] [Accepted: 02/11/2011] [Indexed: 02/01/2023]
Abstract
HYPOTHESIS Resection arthroplasty can be performed for recalcitrant shoulder infection. It is unclear whether a spacer has any benefit. We hypothesized that spacers would increase infection control and improve clinical results. MATERIALS AND METHODS Twenty-one patients were evaluated retrospectively at a mean follow-up of 46.4 months: 11 patients did not receive a spacer (group A), and 10 patients did receive a spacer (group B). Patients were assessed clinically and with radiographs. Patients were scored using the Visual Analog Scale (VAS), Constant-Murley Score (CMS), Simple Shoulder Test, and Disabilities of Arm, Shoulder and Hand. RESULTS Infection was eradicated in 19 patients without additional surgery. Two patients had elevated C-reactive protein and erythrocyte sedimentation rate and were considered to have low-grade infections. Neither patient received a spacer and had not been revised. Infectious control was not significantly different between group A and group B (P = .48). Fourteen patients found the result good or acceptable. The VAS decreased from 6.5 to 2.6. The CMS increased significantly from 17.8 to 40.4. Active abduction averaged 78.1° and active flexion averaged 85.5°. External rotation was 21.0°. DISCUSSION No significant difference was shown between group A and group B. Preservation of the tuberosities was identified as a prognosticator for a good result. Unacceptable pain resulted in 5 patients with a spacer undergoing delayed reimplantation of a prosthesis. CONCLUSION Resection arthroplasty can be offered to patients with long-standing deep shoulder infection that was unresponsive to previous surgical treatment. Control of infection did not differ significantly between the groups. No improvement in outcome was demonstrated with the use of cement spacers.
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Affiliation(s)
- Luk Verhelst
- Department of Orthopaedic Surgery, Leuven University Hospital-Pellenberg, Pellenberg, Belgium.
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Flury MP, Frey P, Goldhahn J, Schwyzer HK, Simmen BR. Reverse shoulder arthroplasty as a salvage procedure for failed conventional shoulder replacement due to cuff failure--midterm results. INTERNATIONAL ORTHOPAEDICS 2010; 35:53-60. [PMID: 20229269 DOI: 10.1007/s00264-010-0990-z] [Citation(s) in RCA: 117] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2009] [Revised: 02/12/2010] [Accepted: 02/12/2010] [Indexed: 11/26/2022]
Abstract
Our goal was to evaluate the objective and subjective midterm outcome after revision of a failed shoulder arthroplasty with a reverse design prosthesis. Twenty consecutive patients with 21 revisions of a primary shoulder arthroplasty using reverse shoulder prosthesis Delta III(®) were followed up postoperatively for a mean of 46 months including clinical and radiological examination. Complications were recorded and Constant score, DASH and SF36 were assessed. With the numbers given a significant reduction of pain was achieved from 8.7 to 3.0 (p < 0.001). There was a significant improvement of active flexion from 43° to 97° (p < 0.001) and active abduction from 44° to 90° (p < 0.001). However, at the same time, active external rotation with an adducted humerus decreased significantly from 26° to 12° (p = 0.012). The constant score improved significantly from 16.7 to 55.9 (p < 0.001). Sixteen patients (84%) rated their shoulder better or much better than before. In 43% an intraoperative and in 38% a postoperative complication occurred including two late stage infections which required prosthesis removal. Our results support the use of the reverse prosthesis as revision prosthesis. The reverse design helps to compensate functional deficits due to severe soft-tissue damage except active external rotation. Nevertheless, the revision is a technically demanding procedure reflected in a high rate of intraoperative complications. The rate of secondary infections of 10% remains a special concern.
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Kirchhoff C, Braunstein V, Paul J, Imhoff AB, Hinterwimmer S. Septic arthritis as a severe complication of elective arthroscopy:clinical management strategies. Patient Saf Surg 2009; 3:6. [PMID: 19335910 PMCID: PMC2669046 DOI: 10.1186/1754-9493-3-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 03/31/2009] [Indexed: 11/10/2022] Open
Abstract
Infection of a peripheral joint following arthroscopic surgery presents with an incidence of approximately 0.42% an extremely rare entity. However, septic arthritis is a serious situation possibly leading to an irreparable joint damage. Especially at delayed diagnosis patients' safety can be endangered severely. Only few precise statements regarding diagnosis and therapy have been published so far. Besides an accurate analysis of the patient's anamnesis and the assessment of the C-reactive protein especially arthrocentesis is required for diagnostic workup. For early stage infections arthroscopic therapy is proven to be of value. In addition a calculated and consecutive germ-adjusted antibiotic therapy is essential. In case of persisting signs of infection the indication for re-arthroscopy or conversion to open revision has to be stated in time. The number of necessary revisions is dependent on the initial stage of infection. For pain therapy postoperative immobilization of the affected joint is occasionally essential, if otherwise possibly early mobilization of the joint should be performed.
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Affiliation(s)
- Chlodwig Kirchhoff
- Department of Orthopedic Sports Surgery, Klinikum Rechts der Isar, Technische Universitaet, Ismaningerstrasse 22, D-81675 Munich, Germany.
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Paul J, Kirchhoff C, Imhoff AB, Hinterwimmer S. [Infection after arthroscopy]. DER ORTHOPADE 2009; 37:1048, 1050-2, 1054-5. [PMID: 18784915 DOI: 10.1007/s00132-008-1309-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Infection of a peripheral joint following arthroscopic surgery is extremely rare, with an incidence of up to 0.42%. However, the consequences of delayed diagnosis can be dramatic. Besides taking an exact patient history, C-reactive protein determination and, especially, diagnostic arthrocentesis are required. For early-stage infections, arthroscopic therapy has been proven valuable. In addition, calculated and antibiogram-adjusted antibiotic therapy is essential. In the case of persisting signs of infection, re-arthroscopy should be considered quickly, with indications broad. The number of necessary revisions depends on the initial stage of infection. Postoperative immobilisation of the affected joint is occasionally essential for treating pain; otherwise, early mobilisation of the joint should be performed.
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Affiliation(s)
- J Paul
- Abteilung und Poliklinik für Sportorthopädie, Klinikum rechts der Isar, Technische Universität, München
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