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Aims: Previous studies have reported concern regarding high reoperation rates when septic arthritis of the native shoulder is treated arthroscopically, compared to open arthrotomy. We aimed to compare re-operation rate between the two strategies. Patients and methods: The review was registered prospectively at PROSPERO, (CRD42021226518). We searched common databases and references lists (8 February 2021). The inclusion criteria included interventional or observational studies of adult patients with a confirmed diagnosis of native shoulder joint septic arthritis and had either arthroscopy or arthrotomy. The exclusion criteria included patients with periprosthetic or post-surgical infections, patients who had atypical infections, and studies that did not report re-operation rate. Cochrane Collaboration's tool for assessing risk of bias (ROBINS-I) was used. Results: Nine studies (retrospective cohort studies) were included that involved 5,643 patients (5,645 shoulders). Mean age ranged from 55.6 to 75.5 years, and follow-up time ranged from 1–41 months. Mean duration of symptoms prior to presentation ranged from 8.3–23.3 days. Metanalysis observed a higher re-operation rate for reinfection at any time point following initial arthroscopy in comparison to arthrotomy, odds ratio 2.61 (95% confidence interval 1.04, 6.56). There was marked heterogeneity (I2 = 78.8%) among studies including surgical techniques and missing data. Conclusion: This metanalysis observed a higher reoperation rate in arthroscopy in comparison to arthrotomy for the treatment of native shoulder septic arthritis in adults. The quality of the included evidence is low and the heterogeneity among included studies is marked. Higher quality evidence is still needed that address limitations of previous studies. [ABSTRACT FROM AUTHOR]

Purpose: Septic arthritis of the native hip joint (SANH) is an uncommon surgical and medical emergency with few reports. The aim of this study was to determine predictors of return to theatre (RTT), complications and mortality. Methods: Patients with SANH were identified from January 2009 to June 2022; 50 patients and three subgroups were identified: Pyogenic (surgical washout without systemic inflammatory disease), Systemic (surgical washout with SIDs) and patients managed non-surgically. Patterns of these groups were assessed with a principal component analysis. The cumulative incidences for death, any complication and RTT for repeat washout were calculated. The predictive variables associated with outcomes were selected with univariable models and then incorporated in multivariable CoxPH regressions. Results: The 1-year cumulative incidence was 14% for mortality and 48.5% for any complication. Amongst patients managed surgically, 1-year risk of RTT was 46% in Pyogenic subgroup and 21% in Systemic subgroup. Systemic subgroup had lower complications and RTT and higher rate of sterile aspirate, compared to Pyogenic. Charlson comorbidity index (CCI) (HR = 1.41, P value = 0.03), preoperative albumin (HR = 0.81, P value = 0.009) and preoperative haemoglobin (HR = 0.95, P value = 0.02) were significantly associated with 1-year mortality. Time between symptom onset and admission > 7 days (HR = 3.15, P value = 0.042), preoperative Hb (HR = 1.05, P value = 0.016), socioeconomic deprivation (HR = 1.18, P value = 0.04) and Systemic subgroup (HR = 0.25, P value = 0.04) were significantly associated with RTT. Conclusion: Mortality was well predicted by the usual parameters including CCI, albumin, but also low haemoglobin. Patients presenting in a delayed fashion were more likely to have multiple lavages. [ABSTRACT FROM AUTHOR]

Purpose: The study was conducted to evaluate clinical and microbiological profile of neonates with septic arthritis and also to assess changing epidemiology in the microbial etiology. Methods: Twenty-nine neonates (1-28 days of life) presenting to the Department of Orthopaedics with acute septic arthritis were included in the study. This was a descriptive study, and the data were collected during the time of hospital admission. History and clinical examination of the neonates were taken, and diagnosis was made based on clinical and laboratory parameters. Emergency arthrotomy was performed to prevent catastrophic sequelae in all the cases given antibiotics as per the culture results. Results: Female children predominated in our study. The children were brought to the OPD with an average of 2.7 days of fever. Thirty-four joints were involved in 29 neonates, out of whom five had more than one joint involvement. Joint effusion or subperiosteal abscess was found in 22 patients by USG. All children had leukocytosis with neutrophilic predominance. Twenty-one of twenty-nine patients had hip-joint involvement followed by knee in seven patients. Gram-negative organisms had grown more commonly, among which Klebsiella pneumonia was grown in nine patients. Conclusion: Prematurity and anemia still appear to be important risk factors for neonatal septic arthritis. As there is changing trend toward gram-negative infections, attention has to be given toward preventing nosocomial and community-acquired infections. This is very important in premature infants who are susceptible for infection when they are kept in resuscitative units in hospitals. [ABSTRACT FROM AUTHOR]

Purpose of study: To evaluate the factors associated with acute hematogenous septic arthritis of the knee in adults and to assess the outcome after open knee arthrotomy. Methods: We performed a prospective evaluation of 26 adult patients with acute nongonococcal septic arthritis of the knee presenting within 7 days. All patients underwent open knee arthrotomy, and final evaluation by means of Knee society score of the affected knee was compared with the contra lateral normal knee. Results: The average duration of symptoms at the time of presentation was 3.9 days. Staphylococcus aureus was the commonest bacteria isolated in 17 (65.4 %) patients. The average duration of follow-up in our study was 18.5 months. In our study, Knee society score decreases as the age of the patient advances ( P < 0.05) and also it was found to be low ( P < 0.05) in the affected knee as compared to contra lateral normal knee. Conclusion: Our study shows that age of the patient at presentation is critical as it shows significant reduction in knee score. This explains that the septic arthritis may contribute to the progression of age-related degeneration of the knee joint. There appears to be no definite contributing factors or conditions associated with acute hematogenous septic arthritis of the knee in adults, although further study may be warranted regarding this matter. [ABSTRACT FROM AUTHOR]

A 9-year-old boy presented with high-grade fever associated with pain and swelling in right hip and left leg of 1-week duration. Pus was found on diagnostic aspiration of the right hip joint. Emergency arthrotomy was performed through anterior approach with drill holes in proximal femur and culture showed MRSA. Intravenous antibiotics were given for 4 weeks. Patient symptomatically improved in immediate postoperative period and in bed hip mobilization was started. On eighth postoperative day, child developed high-grade intermittent fever with chills and rigors and diagnosed as plasmodium falciparum malaria. Fever subsided with antimalarial treatment. On twenty-first day, patient complained pain in right hip and X-ray showed posterior hip dislocation with osteomyelitis of proximal femur. Closed reduction and hip spica application was done under general anesthesia. At follow-up, the clinical result was fair with resolution of infection and stiff hip. [ABSTRACT FROM AUTHOR]

A group of 94 male and 12 female patients who all suffered from ACL ruptures had a follow-up examination after a period of 14 to 21 years (m = 17.2 years). Each of them had undergone a primary arthrotomy with total or partial meniscectomy. In none of the cases, however, had operative repair of the ACL rupture been performed. The most frequent concomitant injury was a torn medial meniscus which occurred in 74.5% of the cases whereas a damaged lateral meniscus was found in 17.0% of the cases only. Chondromalacia of tibia, femur or patella was observed in 42.5% of the cases. Over 60% of the patients resumed their former sports activities, although in nearly 30% of these cases at a lower level whereas one third of the patients had to practice some other sport or were even forced to give up sports completely. 61.3% still complained about instability of the knee joint, 73.6% of the patients with partial or total meniscectomy had developed osteoarthritis of grade III and IV. [ABSTRACT FROM AUTHOR]