Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint

A ten-year retrospective review of patients with acute hematogenous pyogenic arthritis at the Duke University Medical Center yielded 14 affected joints in the pediatric group and 32 in adults. Follow-up ranged from six months to eight years. Analysis of factors possibly affecting end results included the joint involved, organism, duration of infection, antibiotics used, age of the patient, and mode of drainage--whether surgical or by needle aspiration. Surgical drainage in the pediatric group yielded uniformly excellent results. In adults, needle aspiration correlated with increased mortality and morbidity. In contrast to other series in the medical literature we found the indications for needle aspiration to be highly restrictive, and we recommend surgical drainage and appropriate antibiotics as the treatment of choice for most patients with pyogenic arthritis.