Surgical treatment of shoulder infections: a comparison between arthroscopy and arthrotomy

• Published in: Journal of shoulder and elbow surgery Vol. 26; no. 11; pp. 1915 - 1921
• Main Authors: Böhler, Christoph, MD, Pock, Alexander, MD, Waldstein, Wenzel, MD, Staats, Kevin, MD, Puchner, Stephan E., MD, Holinka, Johannes, MD, Windhager, Reinhard, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-11-2017
• Subjects: Aged; Aged, 80 and over; Arthritis, Infectious - microbiology; Arthritis, Infectious - surgery; Arthroscopy; arthrotomy; Female; Humans; Male; Middle Aged; Orthopedics; Recurrence; reinfection; Retrospective Studies; Risk Factors; Septic arthritis; shoulder; Shoulder Joint - surgery; Staphylococcal Infections - surgery; Staphylococcus aureus; treatment; Treatment Outcome; Treatment Study; treatment; arthrotomy; reinfection; risk factors; Septic arthritis; arthroscopy; Retrospective Cohort Design; shoulder; Level III
• ISSN: 1058-2746; 1532-6500
• DOI: 10.1016/j.jse.2017.04.001

Background Management of bacterial shoulder infections includes antibiotic therapy and surgical joint decompression. Arthroscopy and open arthrotomy are recommended treatment options. Whether 1 of the 2 surgical options is superior remains unclear. The present study aimed (1) to compare the reinfection rates after arthroscopy and open arthrotomy and (2) to identify risk factors of reinfection after surgical intervention. Materials and methods The data of 59 consecutive patients were available for final analysis. All patients received arthroscopy or open arthrotomy at our institution between 2001 and 2015. The reinfection rates between the 2 distinct interventions were compared. We also evaluated the influence of potential confounders, such as age, sex, comorbidities, microbiological findings, duration of symptoms, osteoarthritis, Gächter score, and preoperative inflammatory parameters, on the recurrence of infections and compared the functional outcome between the 2 surgery groups. Results From 59 included patients, 38 (64.4%) underwent open arthrotomy, and 21 (35.6%) were treated arthroscopically. Reinfection was documented in 18 patients (30.5%). The reinfection rate was significantly higher in arthroscopically treated patients (11 [52.4%]) than in patients who underwent open arthrotomy (7 [18.4%]; P  = .007). An infection with Staphylococcus aureus negatively influenced the treatment success ( P  = .034). Conclusion According to our data, open arthrotomy is the more effective treatment method in septic arthritis of the shoulder, with lower reinfection rates and a comparable functional outcome. Furthermore, we could identify Staphylococcus aureus as an independent risk factor for the recurrence of infections.