title: Arthroscopic management of native shoulder septic arthritis.
abstract: BACKGROUND
  There is little information on the results of arthroscopic treatment of native shoulder sepsis. Therefore, the purpose of this study was to determine the presentation, preoperative indices, intraoperative findings, and outcomes related to native shoulder sepsis treated with arthroscopy.
  
  
  METHODS
  We retrospectively reviewed 50 consecutive native shoulders with septic arthritis between 1994 and 2008. Patients (75% male) were an average age of 66 years. Four patients had bilateral involvement. All underwent arthroscopic irrigation and debridement. The mean follow-up was 31 months (range, 1-185 months).
  
  
  RESULTS
  Patients were immunocompromised in 57% of cases. The mean preoperative values (normal reference ranges) included white blood cell count, 13 × 10(9)/L (3.5-10.5 × 10(9)/L); erythrocyte sedimentation rate, 66 mm/h (0-29 mm/h), and C-creative protein, 83 mg/L (0-10 mg/L). The average aspiration cell count was 110,988, with a mean differential of 87% neutrophils. The most common organisms were methicillin-susceptible Staphylococcus aureus (44%). Repeat irrigation and debridement was required within the first month in 16 of 50 shoulders (32%). Within 1 year, 17% of patients had died. Final Gächter staging was I or II for 32 shoulders and III or IV for 18 shoulders.
  
  
  CONCLUSIONS
  Most patients with native shoulder sepsis are elderly and immunocompromised and present with increased inflammatory markers and a supporting aspiration cell count. Patients and surgeons must be aware that after initial arthroscopy, 1 in 3 patients will require additional surgical intervention, whether anticipated or not.
  
  
  METHODS
  Level IV, Case Series, Treatment Study.
authors: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
authors: Matthew P
authors: MP
authors: Abdel
authors: Kevin I
authors: KI
authors: Perry
authors: Mark E
authors: ME
authors: Morrey
authors: Scott P
authors: SP
authors: Steinmann
authors: John W
authors: JW
authors: Sperling
authors: Joseph R
authors: JR
authors: Cass
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000276:immunology / Q000601:surgery*; D001182:Arthroscopy; D003646:Debridement; D005260:Female; D006801:Humans; D016867:Immunocompromised Host; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D012785:Shoulder Joint / Q000601:surgery*; D013203:Staphylococcal Infections / Q000601:surgery*; D013211:Staphylococcus aureus; D007507:Therapeutic Irrigation