Septic arthritis as a severe complication of elective arthroscopy:clinical management strategies

Abstract

Infection of a peripheral joint following arthroscopic surgery presents with an incidence of approximately 0.42% an extremely rare entity. However, septic arthritis is a serious situation possibly leading to an irreparable joint damage. Especially at delayed diagnosis patients' safety can be endangered severely. Only few precise statements regarding diagnosis and therapy have been published so far. Besides an accurate analysis of the patient's anamnesis and the assessment of the C-reactive protein especially arthrocentesis is required for diagnostic workup. For early stage infections arthroscopic therapy is proven to be of value. In addition a calculated and consecutive germ-adjusted antibiotic therapy is essential. In case of persisting signs of infection the indication for re-arthroscopy or conversion to open revision has to be stated in time. The number of necessary revisions is dependent on the initial stage of infection. For pain therapy postoperative immobilization of the affected joint is occasionally essential, if otherwise possibly early mobilization of the joint should be performed.

Figure 1

37 year old female, 5 weeks following removal of a tibia nail, developed postoperative pain, swelling, warming and redness of knee joints. Left knee joint: narrowing of joint space, subchondral osteolysis, Gaechter III (intraoperatively classified).

Figure 2

48 year old male, ACL reconstruction 5 weeks ago, postoperative swelling, redness and hyperthermia, CRP 1.3 mg/dl. Aspirate: Staph. epidermidis ++, Intra-OP Gaechter stage II