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Rheumatology Advance Access originally published online on August 20, 2009
Rheumatology 2009 48(10):1320-1322; doi:10.1093/rheumatology/kep220
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Medical vs surgical treatment for the native joint in septic arthritis: a 6-year, single UK academic centre experience

Vinod Ravindran1, Ian Logan1 and Brian E. Bourke1

1Department of Rheumatology, St George's Hospital, London, UK.

Correspondence to: Vinod Ravindran, Department of Rheumatology, St George's Hospital, Blackshaw Road, Tooting, London SW17 0QT, UK. E-mail: drvinod12{at}gmail.com


  Abstract

Objective. Medical treatment (serial closed-needle aspiration) and surgical treatment (arthroscopy/arthrotomy combined with joint washout) are well-recognized methods to treat septic arthritis (SA) of native joints. We compared the outcome of proven SA based on the method of treatment.

Methods. We reviewed case notes of adult patients who were admitted to our institution from January 2001 to December 2006 with proven SA (Newman Grade A organism isolated from the joint).

Results. Thirty-two episodes were treated medically and 19 surgically (4 with arthrotomy, 15 with arthroscopy) in the study period. All had mono-articular SA. No significant difference in the age, symptom duration before treatment and duration of intravenous antibiotic therapy was present between the two groups. Medical treatment resulted in complete recovery in more patients (69 vs 53%, P = 0.24) but longer period of hospitalization [median (interquartile range), 16.5 (14–19) vs 15 (11–17), P = 0.34], although the difference between the groups was not significant. More surgically treated patients had deterioration in functional status at the time of discharge from the hospital (29 vs 44%, P = 0.27), but the difference between the groups was not statistically significant. Surgically treated patients required significantly more sessions of physiotherapy (mean ± S.D., 7 ± 2 vs 10 ± 3, P = 0.002). Mortality was similar (one in each group).

Conclusion. Results from this study show that for the native joint SA, surgical treatment was not superior to the medical treatment and, therefore, highlight the need for careful case selection for surgical intervention.

KEY WORDS: Septic arthritis, Treatment, Outcome, Serial aspiration, Arthroscopy

Submitted 14 April 2009; revised version accepted 23 June 2009.
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