Septic arthritis surgical management

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]

Overview

Surgical management options include:

  • Needle aspiration
    • Closed needle aspiration
    • Open drainage
  • Tidal irrigation
  • Arthroscopy
  • Arthrotomy

There is no specific guidelines for the surgical management but the efficacy of the surgical treatment depends on the clinical condition of the patient.

Surgical management option Description
Needle aspiration Closed needle aspiration
  • Best initial surgical option if joint is easily accessible such as peripheral joints. ( e.g. Knee, ankle, elbow and wrist etc.)
  • Very accessible to remove large amount of purulent synovial fluid unless there is presence of negative prognostic factors such as
  • Useful in repetitive drainage in the management of recurrent infections
Open drainage
  • Open drainage is useful in patients with unaccessible joint involvement such as axial joints (e.g. hip, shoulder and sternoclavicular

joint

Useful in persistant joint tinfections

Tidal irrigation
Arthroscopy
Arthrotomy

As the volume of synovial fluid, the cell count, and the % of polymorphonuclear leukocytes decrease with each aspiration, it is advisable to switch to combination therapy with both antibiotics and needle aspiration whenever needed.

Surgical Management

References


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