title: The use of continuous negative pressure after open debridement for septic arthritis of the shoulder.
abstract: OBJECTIVE
  The treatment of septic arthritis of the shoulder is challenging. The infection frequently recurs and the clinical outcome can be very poor. We aimed to review the outcomes following the use of continuous negative pressure after open debridement with a large diameter drain in patients with septic arthritis of the shoulder.
  
  
  METHODS
  A total of 68 consecutive patients with septic arthritis of the shoulder underwent arthrotomy, irrigation and debridement. A small diameter suction drain was placed in the glenohumeral joint and a large diameter drain was placed in the subacromial space with continuous negative pressure of 15 cm H2O. All patients received a standardised protocol of antibiotics for a mean of 5.1 weeks (two to 11.1).
  
  
  RESULTS
  Negative pressure was maintained for a mean of 24 days (14 to 32). A total of 67 patients (98.5%) were cured without further treatment being required. At a mean follow-up of 14 months (three to 72), the mean forward flexion was 123° (80° to 140°) and the mean external rotation was 28°(10° to 40°) in those with a rotator cuff tear, and 125° (85° to 145°) and 35° (15° to 45°) in those without a rotator cuff tear.
  
  
  CONCLUSIONS
  Continuous negative pressure, following open arthrotomy, irrigation and debridement, was effective in treating septic arthritis of the shoulder. The rate of recurrence was significantly lower than with conventional treatment involving arthroscopic or open debridement reported in the literature. Functional outcomes, even in patients with rotator cuff tears, were excellent.
  
  
  CONCLUSIONS
  Continuous negative pressure is effective in treating septic arthritis of the shoulder. Cite this article: Bone Joint J 2016;98-B:660-5.
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: H J
authors.initials: HJ
authors.lastname: Jung
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J H
authors.initials: JH
authors.lastname: Song
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: A L
authors.initials: AL
authors.lastname: Kekatpure
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: A
authors.initials: A
authors.lastname: Adikrishna
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: H P
authors.initials: HP
authors.lastname: Hong
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: W J
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: J M
authors.initials: JM
authors.lastname: Chun
authors.affiliation: University of Ulsan, 86 Asanbyeongwon-gil, Songpa-gu, Seoul, 138-736, South Korea.
authors.forename: I H
authors.initials: IH
authors.lastname: Jeon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000150:complications / Q000628:therapy*; D003646:Debridement; D004322:Drainage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D054843:Negative-Pressure Wound Therapy; D016059:Range of Motion, Articular; D012189:Retrospective Studies; D000070636:Rotator Cuff Injuries / Q000150:complications; D012785:Shoulder Joint / Q000601:surgery*; D007507:Therapeutic Irrigation
chemical_list: D000900:Anti-Bacterial Agents
keywords: Continuous negative pressure; Open debridement; Recurrence rate; Septic arthritis; Shoulder