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Septic arthritis following arthroscopic meniscus repair: a cluster of three cases
F T Blevins1, J Salgado, D C Wascher
1Department of Orthopaedics, University of New Mexico School of Medicine, Albuquerque, USA.
Abstract:
Three cases of Staphylococcus epidermidis septic arthritis following inside-out arthroscopic meniscus repair within a 4-day period at the same facility are described. All three patients responded to surgical debridement and 4 to 6 weeks of intravenous antibiotics. In each instance, the meniscus and repair sutures were left intact; 12- to 38-month follow-up revealed no evidence of infection or meniscal symptoms. Epidemiological investigation implicated the meniscus repair cannulas as one of the few factors common to all three cases. Molecular typing of bacterial DNA revealed that two of the three isolated organisms showed identical pulsed-field gel electrophoretic patterns, implying a common source of inoculation. Experimental contamination of the cannulas revealed that only sterilization involving ultrasonification, lumen washing by water jet, and steam sterilization resulted in clean and sterile cannulas.
Insights
Three patients developed Staphylococcus epidermidis septic arthritis after arthroscopic meniscus repair. Thorough cannula sterilization, including ultrasonification and water jet washing, is crucial to prevent such infections.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Microbiology
Background:
- Arthroscopic meniscus repair is a common orthopedic procedure.
- Septic arthritis is a serious joint infection that can complicate orthopedic surgery.
- Staphylococcus epidermidis is a common cause of healthcare-associated infections.
Observation:
- Three cases of Staphylococcus epidermidis septic arthritis occurred within four days after inside-out arthroscopic meniscus repair at a single facility.
- All patients were successfully treated with surgical debridement and intravenous antibiotics, with no recurrence of infection or meniscal symptoms at long-term follow-up.
- Epidemiological investigation identified the meniscus repair cannulas as a potential common source of inoculation.
Findings:
- Molecular typing confirmed a common source for two of the three Staphylococcus epidermidis isolates.
- Experimental studies demonstrated that only a multi-step sterilization process (ultrasonification, water jet lumen washing, steam sterilization) effectively eliminated bacterial contamination from the cannulas.
- The meniscus and repair sutures remained intact in all cases, and the infection was managed without compromising the repair.
Implications:
- This highlights the critical importance of rigorous sterilization protocols for arthroscopic surgical instruments, particularly cannulas.
- Implementing advanced sterilization techniques can prevent post-operative infections like septic arthritis following meniscus repair.
- Ensuring sterile cannulas is essential for patient safety and successful outcomes in arthroscopic knee surgery.
