Analysis of native septic hip and knee arthritis

Abstract

Introduction Septic arthritis is a difficult disease for a patient as it is associated with severe complications, sometimes amputations, chronic morbidity and mortality. Thus, prompt differentiation of a bacterial etiology and timely treatment is crucial. Aim The aim of this study was to identify native septic arthritis etiology, pathogenesis and outcomes. Methods Retrospective review was done to identify all patients treated at the hospital LSMU, Department of Orthopedics and Traumatology from 2018 - 2020 for native septic hip and knee arthritis. We investigated microbiological, laboratory, radiological findings, treatment methods and outcomes. Results were evaluated by using MS excel 2010 and SPSS 22.0. Results The study involved 32 patients: 59% (n=19) males and 41% (n=13) females. Majority were treated for coxitis - 63% (n=20) and 37% (n=12) for gonitis. Mean patient age was 60 (SD 15) years. Mean white blood cell (WBC) count in synovial fluid was 71013/μL (SD 75380) and polymorphonuclear cell count was 76% (SD 32). Mean preoperative serum C-reactive protein was 170 mg/l (SD 141) and WBC was 10.5 x10ˆ9/l (SD 10). 69% (n=22) cases were caused by haematogenous pathogen spread, 25% (n=8) – per continuitatem and 6% (n=2) by direct inoculation. 59% (n=19) patients had stage IV according to Gächter. Average duration from manifestation of clinical signs to surgical treatment was 50 days (SD 93). 39% (n=12) patients received antibiotic therapy before hospitalization. There have been done 3 arthroscopies, 28 two-stage techniques (18 with cemented spacer, 10 without) and 1 exarticulation. Microbial growth from synovial fluid or synovial membrane tissue, taken during surgery, was negative 28% (n=9) of all cases, but 4 of them received antibiotic therapy before hospitalization. There were 9% (n=2) polymicrobial infections and the rest were monomicrobial. Most common pathogen was Staph. Aureus (61%, n=14) and othe[...].