Resection arthroplasty for septic arthritis of the sternoclavicular joint

Abstract

Background: Treatment for septic arthritis of the sternoclavicular (SC) joint with concomitant osteomyelitis of the clavicle often requires joint resection rather than simple incision and drainage. We evaluated the effectiveness of resection arthroplasty for patients with septic arthritis of the SC joint.

Methods: We retrospectively reviewed 10 patients who underwent resection arthroplasty for SC joint septic arthritis between 1996 and 2008. The mean patient age was 52.8 ± 10.5 years (range, 40-72 years), the mean symptom duration before surgery was 16.9 days (range, 2-60 days), and the mean follow-up period was 35.4 ± 42.2 months (range, 10-108 months). Diagnoses were based on physical examination, laboratory tests, and radiologic studies including magnetic resonance imaging. Each patient had concomitant osteomyelitis of the clavicle. In addition, 4 patients had mediastinitis and 1 had osteomyelitis of the adjacent ribs. All patients underwent SC joint resection and intramedullary ligament reconstruction, followed by intravenous antibiotics for 4 to 8 weeks. Intraoperative cultures were positive in 6 patients.

Results: All infections resolved, with only 1 patient having complications-systemic sepsis and pneumonia. The mean ranges of motion were 146° of forward flexion (range, 135°-155°) and 48° of external rotation (range, 40°-55°), with the internal rotation level ranging from T5 to L3. The mean superior migration of the clavicle was 1.5 mm (range, 0-4 mm), and the mean visual analog pain score was 1.4 ± 0.7 (range, 0-2).

Conclusion: Resection arthroplasty in patients with septic SC joints results in relatively good shoulder function.