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Postarthroscopy surgical site infections: review of the literature
Hilary M Babcock1, Matthew J Matava, Victoria Fraser
1Infectious Disease Division, Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA. hbabcock@im.wustl.edu
Abstract:
The use of arthroscopy for both diagnosis and operative intervention has been increasing steadily since its introduction in the 1970s. It is generally associated with fewer complications and shorter times to mobilization than are open procedures. Overall reported rates of complications are low (0.1%-0.6% of procedures). This review focuses on infectious complications of arthroscopy, which are rare (0.01%-0.48% of procedures) but result in significant morbidity for the patient when they occur. The most commonly reported causative organisms are staphylococci. Several outbreaks have been reported related to breaks in infection control or to contaminated instruments. Suggested risk factors include use of intra-articular corticosteroids, prolonged tourniquet time, patient's age >50 years, failure to prepare the surgical site again before conversion to arthrotomy, procedure complexity, and a history of previous procedures. However, most reports use variable and unclear definitions of infection, which makes it difficult to draw firm conclusions.
Insights
Arthroscopy offers benefits over open surgery, but rare infectious complications can cause significant patient harm. Understanding risk factors is crucial for preventing these rare arthroscopic surgery infections.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Minimally Invasive Procedures
Background:
- Arthroscopy has become a common diagnostic and operative tool since the 1970s.
- Compared to open procedures, arthroscopy generally leads to fewer complications and faster patient mobilization.
- Reported overall complication rates for arthroscopy are low, ranging from 0.1% to 0.6%.
Purpose of the Study:
- To review infectious complications associated with arthroscopic procedures.
- To identify common causative organisms and potential risk factors for arthroscopic infections.
- To highlight challenges in defining and reporting arthroscopic infections.
Main Methods:
- Literature review focusing on infectious complications of arthroscopy.
- Analysis of reported causative organisms, particularly staphylococci.
- Examination of identified risk factors and outbreak-related causes.
Main Results:
- Infectious complications of arthroscopy are rare, occurring in 0.01% to 0.48% of procedures.
- Staphylococci are the most frequently identified pathogens in arthroscopic infections.
- Outbreaks are often linked to lapses in infection control or contaminated equipment.
Conclusions:
- While rare, infectious complications from arthroscopy can lead to substantial patient morbidity.
- Factors such as corticosteroid use, prolonged tourniquet times, and patient age may increase risk.
- Inconsistent definitions of infection in existing literature hinder definitive conclusions on risk factors and prevention.
