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Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts.

PMID: 33755737 (view PubMed database entry)
DOI: 10.1007/s00167-021-06525-8 (read at publisher's website )
PMCID: PMC8458194 (free full text version available)

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Andreas Voss, Christian G Pfeifer, Maximilian Kerschbaum, Markus Rupp, Peter Angele, Volker Alt,

<h4>Purpose</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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.<h4>Conclusion</h4>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.<h4>Level of evidence</h4>IV.

Knee Surg Sports Traumatol Arthrosc (Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA)
[2021, 29(10):3149-3158]

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