title: Post-arthroscopy septic arthritis: Current data and practical recommendations.
abstract: Septic arthritis develops after less than 1% of all arthroscopy procedures. The clinical symptoms may resemble those seen after uncomplicated arthroscopy, raising diagnostic challenges. The diagnosis rests on emergent joint aspiration with microscopic smear examination and prolonged culturing on specific media. Urgent therapeutic measures must be taken, including abundant arthroscopic lavage, synovectomy, and the concomitant administration of two effective antibiotics for at least 6 weeks. Preservation of implants or transplants is increasingly accepted, and repeated joint lavage is a component of the treatment strategy. After knee arthroscopy, infection is the most common complication; most cases occur after cruciate ligament reconstruction, and staphylococci are the predominant causative organisms. Emergent synovectomy with transplant preservation and appropriate antibiotic therapy ensures eradication of the infection in 85% of cases, with no adverse effect on final functional outcomes. After shoulder arthroscopy, infection is 10 times less common than neurological complications and occurs mainly after rotator cuff repair procedures; the diagnosis may be difficult and delayed if Propionibacterium acnes is the causative organism. The update presented here is based on both a literature review and a practice survey. The findings have been used to develop practical recommendations aimed at improving the management of post-arthroscopy infections, which are exceedingly rare but can induce devastating functional impairments.
authors.affiliation: Service de Chirurgie Orthopédique, Hôpital Ambroise-Paré, Hôpitaux Universitaires Paris Île-de-France Ouest, 9, avenue Charles-de-Gaulle, 92100 Boulogne-Billancourt, France. Electronic address: thomas.bauer@apr.aphp.fr.
authors.forename: T
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Service de Chirurgie Orthopédique, Hôpital André-Mignot, 177, rue de Versailles, 78150 Le Chesnay, France.
authors.forename: P
authors.initials: P
authors.lastname: Boisrenoult
authors.affiliation: Service de Chirurgie Orthopédique, Centre Chirurgical Orthopédique et de la Main, 10, avenue Achille-Baumann, 67400 Illkirch, France.
authors.forename: J Y
authors.initials: JY
authors.lastname: Jenny
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D001182:Arthroscopy / Q000009:adverse effects*; D016908:Gram-Positive Bacterial Infections / Q000150:complications; D006801:Humans; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D011425:Propionibacterium acnes; D012785:Shoulder Joint / Q000601:surgery*; D013203:Staphylococcal Infections / Q000150:complications*; D011795:Surveys and Questionnaires; D000074402:Synovectomy; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Arthroscopy; Infection; Septic arthritis; Synovectomy