Comparison of Arthroscopic and Open Treatment of Septic Arthritis of the Wrist

Sammer, Douglas M.; Shin, Alexander Y.
March 2010
Journal of Bone & Joint Surgery, American Volume;Mar2010 Supplement 1, Vol. 92-A, p107
Academic Journal
BACKGROUND: Open irrigation and débridement is the standard of treatment for septic arthritis of the wrist. Although isolated cases of arthroscopic irrigation and débridement have been reported, a comparison of arthroscopic and open techniques has not been performed, to our knowledge. The purpose of this study was to compare the two methods of management. METHODS: A retrospective comparison of patients with septic arthritis of the wrist initially treated, over an eleven- year period, with open or arthroscopic irrigation and débridement was undertaken at a single institution. The clinical presentation, laboratory and microbiological findings, hospital course, complications, and outcomes were compared between the two groups. RESULTS: Between 1997 and 2007, thirty-six patients with septic arthritis involving a total of forty wrists were identified. Nineteen wrists (seventeen patients) were initially treated with open irrigation and débridement, and twenty-one wrists (nineteen patients) were initially treated arthroscopically. Eleven wrists in the open-treatment cohort required repeat irrigation and débridement, and eight wrists in the arthroscopy cohort required a repeat procedure. If a repeat irrigation and débridement was required, it was performed in an open fashion in all but two cases. When the comparison included all of the patients in the series, no difference between the two cohorts was found with regard to the number of irrigation and débridement procedures required or the length of the hospital stay. However, when the comparison was limited to the patients with isolated septic arthritis of the wrist, it was found that only one of seven wrists in the open- treatment cohort but all eight wrists in the arthroscopy cohort had been successfully managed with a single irrigation and débridement procedure (p = 0.001). No patient in whom isolated septic arthritis of the wrist had been treated with arthroscopic irrigation and débridement required a second operation. The patients in whom isolated septic arthritis of the wrist was treated with the open method stayed in the hospital for an average of sixteen days compared with a six-day stay for those in whom isolated septic arthritis of the wrist was treated with the arthroscopic method (p = 0.04). The ninety-day perioperative mortality rate in the series was substantial (18% [three patients] in the open-treatment cohort and 21% [four patients] in the arthroscopy cohort). CONCLUSIONS: Arthroscopic irrigation and débridement is an effective treatment for patients with isolated septic arthritis of the wrist; these patients had fewer operations and a shorter hospital stay than did patients who had received open treatment. However, these benefits were not seen in patients with multiple sites of infection. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions to Authors for a complete description of levels of evidence.


Related Articles

  • Tratamiento artroscópico de la osteoartritis: rodilla y hombro. Almazán, Arturo; Cruz, Francisco; Pérez, Francisco; Bravo, César; Ibarra, Clemente // Reumatologia Clinica;Supplement 3-Oct, Vol. 3 Issue 4, p44 

    We discuss the role of arthroscopy in the treatment of knee and shoulder osteoarthritis. The most widely used arthroscopic techniques used in these joints for the treatment of osteoarthritis are arthroscopic lavage, arthroscopic debridement, abrasion arthrosplasty and microfractures. Even though...

  • ARTHROSCOPIC AND OPEN SYNOVECTOMY OF THE ELBOW IN RHEUMATOID ARTHRITIS. Tanaka, Nobuyuki; Sakahashi, Hisashi; Hirose, Kazuya; Ishima, Takumi; Ishii, Seiichi // Journal of Bone & Joint Surgery, American Volume;Mar2006, Vol. 88-A Issue 3, p521 

    Background: Synovectomy has been advocated for early treatment of the rheumatoid elbow. It has not been determined whether arthroscopic or open synovectomy is better and whether a preoperative arc of flexion of >90° is an important prognostic factor. Methods: Arthroscopic or open synovectomy...

  • Time delay between diagnosis and arthroscopic lavage in septic arthritis. Does it matter? Kodumuri, Preetham; Geutjens, Guido; Kerr, Hui-Ling // International Orthopaedics;Aug2012, Vol. 36 Issue 8, p1727 

    Purpose: Septic arthritis is a life-threatening emergency with high mortality of up to 11 %. We investigated if delay of arthroscopic lavage of infected major joints would have a bearing on the mortality and morbidity such as admission to an intensive care unit (ICU). Methods: We retrospectively...

  • Volume of a wash and the other conditions for maximum therapeutic effect of arthroscopic lavage in rheumatoid knees. Tanaka, Nobuyuki; Sakahashi, Hisashi; Hirose, Kazuya; Ishima, Takumi; Ishii, Seiichi // Clinical Rheumatology;Feb2006, Vol. 25 Issue 1, p65 

    The objective of this study was to determine the appropriate volume of saline to obtain a beneficial effect of arthroscopic lavage and the prognostic factors related to the clinical effect in a refractory rheumatoid knee. Arthroscopic lavage or arthrocentesis was performed in a random manner in...

  • SPOTLIGHT ON SEPTIC ARTHRITIS. Kosolofski, Hayley // Horse-Canada.com;2016 Canadian Horse Annual- Special Issue, p16 

    The article focuses on septic arthritis, which is caused by a bacterial infection in a horse's joint. Topics discussed include treatment of the disease by arthroscopic lavage; side effects of the antibiotic therapy include diarrhea; identification of the protein marker serum amyloid A, which was...

  • THE ADDITION OF EPINEPHRINE TO IRRIGATION FLUID DURING ARTHROSCOPIC SHOULDER SURGERY REDUCED BLEEDING AND INCREASED VISUALIZATION. Jensens, KH; Werther, K; Stryger, V; Schultz, K; Falkenberg, B // Journal of Bone & Joint Surgery, American Volume;May2002, Vol. 84-A Issue 5, p885 

    Investigates the effect of epinephrine on the irrigation fluid in arthroscopic shoulder surgery in Denmark. Placement of patients in the lateral position; Clarity of the visual field after the procedure; Reduction of intra-articular bleeding.

  • Case report: rheumatoid arthritis occurring during observation after surgery for localized pigmented villonodular synovitis. Hirose, Isao; Mori, Yujiro; Fujimoto, Akihiko // Modern Rheumatology (Springer Science & Business Media B.V.);Sep2003, Vol. 13 Issue 3, p281 

    In the rare case presented here, arthroscopic resection was performed after a diagnosis of localized pigmented villonodular synovitis (LPVS) of the knee, but the disorder recurred after about 1 year as the diffuse form, and synovectomy was performed through a medial parapatella incision....

  • LOW-TECH HELP FOR ACHY KNEES.  // Good Housekeeping;Mar2009, Vol. 248 Issue 3, p36 

    The article highlights a 178-person study which finds that arthroscopic surgery offered no additional benefit over a regimen of physical therapy in treating arthritis in Canada. It states that the procedure seemed to bring relief only in post-op physical therapy. According to orthopedist Robert...

  • Arthroscopic treatment of early glenohumeral arthritis. Porcellini, Giuseppe; Merolla, Giovanni; Campi, Fabrizio; Pellegrini, Andrea; Bodanki, Chandra; Paladini, Paolo // Journal of Orthopaedics & Traumatology;Mar2013, Vol. 14 Issue 1, p23 

    Background: The articular cartilage of the shoulder is not endowed with intrinsic repair abilities, so the detection of chondral lesions during arthroscopy may indicate that additional articular procedures are needed. The aim of the current study was to evaluate the benefits of arthroscopy in...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics