Post-arthroscopy septic arthritis: Current data and practical recommendations.

Area of Science:

• Orthopedic Surgery
• Infectious Diseases
• Microbiology

Background:

• Septic arthritis following arthroscopy is uncommon (<1%) but presents diagnostic challenges due to similar symptoms to uncomplicated procedures.
• Infections are most frequent after knee arthroscopy (cruciate ligament reconstruction) and shoulder arthroscopy (rotator cuff repair).
• Staphylococci and Propionibacterium acnes are common causative organisms, with P. acnes potentially causing delayed diagnosis.

Purpose of the Study:

• To review current literature and practice surveys on post-arthroscopy septic arthritis.
• To develop practical recommendations for improved management of these rare but severe complications.
• To highlight diagnostic difficulties and effective treatment strategies for septic arthritis after arthroscopic procedures.

Main Methods:

• Literature review and practice survey.
• Analysis of diagnostic methods including joint aspiration, microscopy, and prolonged culturing.
• Evaluation of treatment strategies involving arthroscopic lavage, synovectomy, and antibiotic therapy.

Main Results:

• Early diagnosis relies on joint aspiration and culture; treatment requires urgent arthroscopic lavage, synovectomy, and 6-week antibiotic courses.
• Implant/transplant preservation and repeated lavage are accepted treatment components.
• Successful infection eradication (85%) with good functional outcomes is achievable with timely synovectomy and antibiotics, even with transplant preservation.

Conclusions:

• Post-arthroscopy septic arthritis requires prompt diagnosis and aggressive management, including surgical intervention and prolonged antibiotics.
• Management strategies focusing on transplant preservation and thorough lavage contribute to favorable functional outcomes.
• Recommendations are provided to enhance the care of patients with post-arthroscopy infections, minimizing functional impairment.