Septic Arthritis: The drainage controversy

de Jong PH*, Bisoendial RJ and Lems WF

Objective: Septic arthritis is a relatively rare disease, which is associated with a high morbidity and mortality. Treatment consists of prolonged antibiotic therapy and removal of intra-articular inflammatory debris. However, there is much controversy about the most effective drainage method. Therefore, we compared the clinical efficacy of (daily) needle aspiration with surgical drainage in adult patients with septic arthritis.

Methods: In this systemic review, all articles describing treatment outcomes based upon the drainage method were retrieved. We also performed a meta-analysis, irrespective of the clinical or methodological heterogeneity.

Results: We included 5 studies, all retrospective in nature, and if combined, with a total number of 450 patients. These studies showed that complete rehabilitation occurred more often in septic arthritis patients treated with needle aspirations (67-76%) compared to surgically treated patients (32-56%). The pooled relative risk (RR) (95% confidence interval (CI)) for complete rehabilitation in needle aspirations compared to surgical drainage was 1.46 (1.22–1.75). On the other hand, the mortality rate was slightly higher in the daily aspiration group (respectively 3-13% versus 2.5-5%). The pooled RR (95% CI) for mortality in needle aspiration versus surgical treatment was 2.23 (0.84-5.91). Noteworthy is the fact that serious underlying illnesses were more frequent in the needle aspiration group. 

Conclusion: We recommend (daily) needle aspirations as initial method of drainage in patients with an uncomplicated septic arthritis, except for following more complex/difficult situations, in which surgical drainage is preferred: (1) inaccessible joints; (2) unsatisfactory clinical response; and (3) inability to aspirate the joint dry.

Keywords: Septic arthritis; Drainage method; Needle aspiration; Surgical drainage; Clinical efficacy and adults

Published on: Sep 24, 2018 Pages: 1-5

Full Text PDF Full Text HTML DOI: 10.17352/raoa.000008
CrossMark Publons Harvard Library HOLLIS Search IT Semantic Scholar Get Citation Base Search Scilit OAI-PMH ResearchGate Academic Microsoft GrowKudos Universite de Paris UW Libraries SJSU King Library SJSU King Library NUS Library McGill DET KGL BIBLiOTEK JCU Discovery Universidad De Lima WorldCat VU on WorldCat