Medical Versus Surgical Approach to Initial Treatment in Septic Arthritis: A Single Spanish Center’s 8-Year Experience

• Published in: Journal of clinical rheumatology Vol. 25; no. 1; pp. 4 - 8
• Main Authors: Flores-Robles, Bryan Josué, Jiménez Palop, Mercedes, Sanabria Sanchinel, Abel Alejandro, Andrus, Robert Francis, Royuela Vicente, Ana, Sanz Pérez, Marta Isabel, Espinosa Malpartida, María, Ramos Giráldez, Consuelo, Merino Argumanez, Carolina, Villa Alcázar, Luis Fernando, Andréu Sánchez, José Luis, Godoy Tundidor, Hildegarda, Campos Esteban, José, Sanz Sanz, Jesús, Barbadillo Mateos, Carmen, Isasi Zaragoza, Carlos, Mulero Mendoza, Juan
• Format: Journal Article
• Language: English
• Published: United States Copyright Wolters Kluwer Health, Inc. All rights reserved 01-01-2019; Lippincott Williams & Wilkins
• Subjects: Adult; Aged; Anti-Bacterial Agents - therapeutic use; Arthritis, Infectious - drug therapy; Arthritis, Infectious - surgery; Arthrocentesis; Arthroscopy; Female; Humans; Male; Middle Aged; Original; Recovery of Function; Retrospective Studies; Spain; Treatment Outcome; Spain
• ISSN: 1076-1608; 1536-7355
• DOI: 10.1097/RHU.0000000000000615

OBJECTIVEThe aim of this study was to compare the functional results of 2 different procedure types, medical or surgical used in treating native joint septic arthritis.
METHODSIn this cohort study, we reviewed the clinical registries of patients admitted to a single third-level hospital with the diagnosis of septic arthritis during the period of January 1, 2008, to January 31, 2016.
RESULTSA total of 63 cases of septic arthritis were identified in which the initial approach for 49 patients was medical (arthrocentesis), whereas the initial approach for 14 patients was surgical (arthroscopy or arthrotomy). Of the 49 patients who received initial medical treatment (IMT), 15 patients (30%) later required surgical treatment because of poor progress. The median age of the patients was 60 (SD, 18) years. The group who received IMT were older than those who received initial surgical treatment (median, 64 years [interquartile range {IQR}, 54–76 years], vs. 48 years [IQR, 30–60 years]). There was a larger percentage of male patients in the surgical group (78% vs. 42% [p = 0.018]). Thirty percent of the medical group had been receiving corticosteroid treatment (p = 0.018). Results of complete recovery of joint functionality showed no significant differences after 1 year (68% with MT vs. 67% with ST, p = 0.91). Both groups had similar symptom duration until diagnosis, duration of antibiotic therapy (median, 30 days [IQR, 28–49 days], vs. 29.5 days [IQR, 27–49] days), and mortality rate (3 in the medical group).
CONCLUSIONSThe results of the study show that initial surgical treatment in patients with native joint septic arthritis is not superior to IMT. However, half of the patients with shoulder and hip infections treated with IMT eventually required surgical intervention, suggesting that perhaps this should be the preferred initial approach in these cases.