title: Time delay between diagnosis and arthroscopic lavage in septic arthritis. Does it matter?
abstract: OBJECTIVE
  Septic arthritis is a life-threatening emergency with high mortality of up to 11 %. We investigated if delay of arthroscopic lavage of infected major joints would have a bearing on the mortality and morbidity such as admission to an intensive care unit (ICU).
  
  
  METHODS
  We retrospectively reviewed patients presenting with septic arthritis to two regional hospitals over a period of seven years from 1 January 2005 to 31 December 2011. We divided our sample of 82 patients into four groups based on the time delay between clinical diagnosis and arthroscopic lavage ranging from less than six hours to more than 24 hours.
  
  
  RESULTS
  We determined that 35.4 % of patients had prosthetic joints. Knee joints were predominantly involved (74.4 %). Staphylococcus aureus was the most commonly isolated pathogen (41.5 %). There were ten (12.2 %) deaths and the same number of admissions to an ICU. Our study revealed there was no statistical significance between the time delay and mortality (P = 0.25) or ICU admission (P = 0.74) or the number of washouts (P = 0.08) in all four groups.
  
  
  CONCLUSIONS
  Up to 48 hours delayed arthroscopic lavage for septic arthritis does not increase the risk of mortality. Further prospective large sample studies are recommended to investigate this and the risk of long-term morbidity.
authors.affiliation: Nottingham University Hospitals, Nottingham, UK. dr.preetham.k@gmail.com
authors.forename: Preetham
authors.initials: P
authors.lastname: Kodumuri
authors.forename: Guido
authors.initials: G
authors.lastname: Geutjens
authors.forename: Hui-Ling
authors.initials: HL
authors.lastname: Kerr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000401:mortality* / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D057210:Delayed Diagnosis; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007719:Knee Joint / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013203:Staphylococcal Infections / Q000401:mortality* / Q000601:surgery*; D013211:Staphylococcus aureus / Q000302:isolation & purification; D015996:Survival Rate; D007507:Therapeutic Irrigation / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome