From the Guidelines
The patient with septic arthritis requires urgent surgical drainage, typically through arthroscopic or open joint debridement, to remove infected synovial fluid, debris, and necrotic tissue from the affected joint. This procedure is necessary to prevent joint destruction and systemic complications, as delays in treatment can lead to significant morbidity and mortality [(1, 2)]. The specific approach depends on the affected joint, with arthroscopy often preferred for larger joints like the knee or shoulder, while smaller joints may require open arthrotomy.
- Key considerations for the surgical procedure include: + Urgent performance to minimize joint damage and systemic complications + Collection of multiple samples for culture and sensitivity testing to guide antibiotic therapy + Irrigation of the joint with antibiotic solution and temporary placement of a drain, if necessary
- Postoperative care involves intravenous antibiotics for 2-4 weeks, followed by oral antibiotics for a total of 4-6 weeks, as recommended by the Infectious Diseases Society of America [(1, 2)]. The choice of antibiotics should be guided by culture and sensitivity results, with initial broad-spectrum coverage (such as vancomycin plus ceftriaxone or piperacillin-tazobactam) until specific pathogens are identified. Surgical intervention is crucial because antibiotics alone cannot adequately penetrate the infected joint space to clear the infection, and the purulent material must be physically removed to prevent ongoing damage to the cartilage and bone.
From the Research
Surgical Treatment for Septic Arthritis
The patient may require one of the following surgical treatments for septic arthritis:
- Arthroscopic irrigation and debridement (I&D)
- Open irrigation and debridement (I&D)
Comparison of Arthroscopic and Open I&D
Studies have compared the outcomes of arthroscopic and open I&D for septic arthritis of the native knee, with some findings including:
- No significant difference in 90-day reoperation rate between arthroscopic and open I&D 3
- Lower rates of readmission, postoperative anemia, and blood transfusion with arthroscopic I&D compared to open I&D 3
- Arthroscopic I&D may be preferable to open treatment in the management of septic arthritis of the native knee in certain cases 3
Non-Surgical Treatment
In some cases, septic arthritis may be treated without surgery, particularly in patients who are not critically ill at presentation:
- Nonoperative patients were older and less likely to have prior joint pathology 4
- Nonoperative patients had a relatively high survival rate (88%) and no significant sequelae in post-discharge imaging 4
Diagnosis and Treatment
Septic arthritis must be promptly diagnosed and treated to prevent permanent morbidity and mortality:
- Risk factors for septic arthritis include age, diabetes mellitus, rheumatoid arthritis, and immunosuppressive medication use 5
- Synovial fluid studies are required to confirm the diagnosis, and empiric antibiotic therapy should be initiated if there is clinical concern for septic arthritis 5
- Total duration of therapy ranges from two to six weeks, depending on the causative microorganism 5