Recent advances in the management of septic arthritis
The consequences of septic arthritis include joint destruction in some cases and death in others. As such, septic arthritis may be regarded as a medical and surgical emergency. In the era of joint replacement surgery, septic arthritis now takes on a new dimension to include acute infections of joint prostheses. Both the management and outcome of prosthetic infections are complex. Recognition of risk factors is important to maximize the potential for normal joints to resist infection. Systemic and local factors combine to impair the host’s ability to respond to infection. The rise of intravenous drug use and immunosuppression may account for a variety of less common infections. Investigations are becoming more sophisticated with better anatomic and functional imaging. Identifying microbiologic agents may also be enhanced through the use of molecular analyses. Typing of specific organisms has allowed the tracing of bacterial sources and the mechanisms of recurrent or regional spikes in infection.
Management of infections is through the combination of aggressive joint lavage or debridement in conjunction with appropriate antibiotic therapy. The commonest organisms are staphylococcal but resistant organisms are being seen more commonly.
Prosthetic joint infection is a devastating clinical problem and management of this in the acute setting remains controversial. The principle of management, however, remains similar to native joint infection which is to identify the organism, debride the infected tissue aggressively and provide appropriate and adequate quantities of antibiotic therapy. In some cases joint excision is also required. Our experience with salvage of infected prostheses will be presented.
(Professor Peter F.M. Choong Professor and Director of Orthopaedics St. Vincent’s Hospital Melbourne, Department of Surgery University of Melbourne, Victoria, Australia)