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

Characteristics of Septic Arthritis of the Foot and Ankle in Children-Review of a Retrospective Multicenter Database

BACKGROUND

There are few publications on the presentation and management of septic arthritis of the foot and/or ankle (SAFA) in children. The purpose of this study was to describe the presenting characteristics, microbiologic profile, and treatment outcomes of SAFA in a pediatric population from a multicenter database.

METHODS

Patients aged 18 years or younger with SAFA were identified from a multicenter retrospective musculoskeletal infection database. Demographics, laboratory tests, culture results, surgical data, and complications were collected.

RESULTS

A total of 684 patients were identified to have SA. Patients who had SA of the ankle and/or foot with or without concomitant lower leg musculoskeletal infection were included, yielding 82 patients (12%). The median age of the cohort was 7.0 years (range, 0.5 to 15.8 years), and 56% were male (46/82). Fifty-nine percent of the cohort had ankle-only involvement (48/82), 15% had foot only (12/82), 2% had ankle and foot (2/82), and 24% had ankle and leg (20/82). Fifty-two percent of patients had an additional diagnosis to SA, the most frequent being osteomyelitis (39/82; 48%). Ninety-four percent of patients underwent surgical irrigation and debridement, with 12 patients (16%) receiving more than one surgical intervention. Positive tissue cultures were obtained in 77% (59/79), with methicillin-sensitive Staphylococcus aureus being the most commonly identified organism. Three patients (4%) had recurrence of SAFA, and two of those patients underwent additional surgery. Musculoskeletal complications were rare, with osteonecrosis and pathologic fracture being the most common (4%).

CONCLUSION

In children with SA, 12% of cases occur within the foot and/or ankle, with ankle-only involvement being the most common presentation. Methicillin-sensitive Staphylococcus aureus is the most common causative organism. In patients with SAFA, multifocal infection occurs relatively frequently, but antibiotic treatment combined with irrigation and débridement results in excellent short-term outcomes with low rates of recurrence and complications.

LEVEL OF EVIDENCE

Level IV, prognostic.

Complications after arthroscopic knee surgery

PURPOSE

To examine the complications of arthroscopic knee surgeries conducted in the Sports Medicine and Knee Center of our hospital.

SUBJECTS AND METHODS

In this prospective study, a total of 2,623 patients (1,396 men and 1,227 women) who underwent arthroscopic knee surgeries in our center between January 2006 and March 2013 (7 years and 3 months) were studied. The ages at surgery ranged 7-96 years (mean 33.5 years). Arthroscopy was conducted because of sports injuries in 1,653 patients (63.0 %). The main diagnoses included meniscal injury in 920 patients, discoid meniscus in 64 patients, anterior cruciate ligament injury in 580 knees, posterior cruciate ligament injury in 30 knees, loose body in 61 knees, and intraarticular fracture in 33 knees. Arthroscopic procedures included meniscectomy in 987 knees, meniscal suture repair in 262 knees, and anterior cruciate ligament reconstruction in 508 knees. Intraoperative and postoperative complications in these cases were investigated.

RESULTS

The rate of complication was 7 in 2,623 cases (0.27 %). Intraoperative complications comprised three cases of intraarticular instrument breakage and one case of meniscal injury. Postoperative complications consisted of two cases of septic arthritis and one case of superficial infection, and reoperation was necessary in the two cases of septic arthritis. There were no neural, vascular and ligament injuries during surgery, and no complex regional pain syndrome, symptomatic deep vein thrombosis, and pulmonary embolism were observed.

CONCLUSION

Arthroscopic knee surgeries are considered to be minimally invasive, and are conducted relatively safe with low complication rates. In this series, however, seven cases of complications occurred, including two cases (0.08 %) of septic arthritis. Furthermore, symptomatic thromboembolism has been reported to occur also in arthroscopic surgery. The risk of severe complications has to be acknowledged.

Arthroscopic synovectomy, irrigation, and debridement for treatment of septic ankle arthrosis: a systematic review and case series

Septic arthrosis of the ankle is a rare, often devastating, infection, with a high potential for morbidity and mortality. Delay in treatment can lead to cartilage erosion, painful synovitis, and osteomyelitis. Septic ankle arthrosis deserves prompt recognition and intervention. However, quality, sound, protocol-directed arthroscopic treatment of septic ankle arthrosis of the ankle has not yet been reported. We performed a systematic review of the electronic databases and other relevant peer-reviewed sources to determine the outcomes and treatment protocols associated with septic ankle arthrosis treated with arthroscopic synovectomy, irrigation, and debridement. Nine studies, involving a total of 15 ankles, met our inclusion criteria. In addition, we present the short-term outcomes of a protocol-driven arthroscopic synovial biopsy, deep culture procurement, synovectomy, irrigation, and debridement approach for 8 ankles (8 patients). To our knowledge, this would be the largest individual case series specific to arthroscopic treatment of septic ankle arthrosis. The most common infectious organism reported in the systematic review and in our case series was methicillin-sensitive Staphylococcus aureus. Arthroscopic synovectomy, irrigation, and debridement represents an acceptable treatment method for septic ankle arthrosis and demonstrated outcomes similar to the more traditional open approach, with fewer complications. Additional, appropriately weighted, randomized controlled studies with long-term follow-up are warranted.