Septic arthritis: Arthroscopic management with local antibiotic treatment

In a retrospective study, the results of arthroscopic treatment of septic arthritis were evaluated in 12 patients. Ages ranged from 4 to 57 years. The knee joint was affected in 9 cases, the elbow in 2 cases, and the shoulder joint in one case. In 3 patients the infection was hematogenous. Four patients had a postoperative infection and in 5 patients the infection followed an intraarticular injection. The indication for arthroscopic treatment was based on clinical findings, an increased ESR and/or CRP, an increase in leukocyte count in the joint fluid and no bone involvement on x-ray. Arthroscopic management was performed according to the intraoperative findings (lavage, debridement, synovectomy). The procedure was completed by intraarticular placement of an antibiotic collagenous fleece. Additionally systemic antibiotics, active against staphylococcus aureus, were used for perioperative therapy before starting a specific antibiotic treatment according to the cultured organism. In 10 out of 12 cases the infection was cured by one operation. Because of the advantages of arthroscopic treatment, it should be performed as soon as joint infection is confirmed.