Department of Orthopedics, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Korea.
Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, 20, Geumo-ro, Mulgeum-eup, Yangsan-si, 50612, Gyeongsananam-do, Korea.
Eur Radiol. 2022 Mar;32(3):1419-1428. doi: 10.1007/s00330-021-08238-5. Epub 2021 Oct 12.
To investigate the clinical and radiologic predictors of postoperative recurrent septic arthritis of the shoulder (SAS) using multivariable analysis.
Forty-three patients (mean age, 65 years; 24 women) who underwent surgery for SAS between January 2011 and October 2019 were retrospectively enrolled. An orthopedic surgeon assessed clinical (age, sex, comorbidity, duration from symptom onset to MR imaging and surgery, surgical method, antibiotic usage), laboratory (serum white blood cell [WBC] count, C-reactive protein [CRP] level, synovial cell count), and surgical findings (culture/biopsy results). Two musculoskeletal radiologists evaluated MR imaging findings (bone marrow [reactive bone marrow edema, osteomyelitis, osteochondral erosion] and soft tissue [synovitis, bursitis, muscle edema, abscess] abnormalities). Recurrent SAS was evaluated at ≥ 12 months postoperatively. Univariable and multivariable analyses were performed to determine the best predictor of recurrent SAS.
The overall recurrent SAS rate was 33% (14/43). On univariable analysis, mean age (without recurrence vs. recurrence: 68 vs. 59 years, p = .04), mean duration from symptom onset to surgery (18 vs. 25 days, p = .02), serum WBC count (12,000 vs. 9,000 cells/mL, p = .04), CRP level (13 vs. 6 mg/L, p = .01), and osteomyelitis on MR imaging (p < .01 for both readers) significantly differed between patients with and without recurrence; on multivariable analysis, only osteomyelitis on MR imaging was significantly associated with recurrent SAS for both readers (p = .02 and .01 for each reader respectively). The inter-reader agreement was good (κ = .62-1.0) for all MR imaging findings, except for muscle edema (fair, κ = .37).
Osteomyelitis on MR imaging was the best predictor of recurrent SAS.
• Osteomyelitis on preoperative MR imaging was the best predictor associated with recurrent septic arthritis of the shoulder on multivariable analysis including clinical, laboratory, and MR findings. • In multivariable analyses focused on each bone marrow abnormality, with adjustment for clinical and laboratory parameters, the presence of reactive bone marrow edema and osteochondral erosion on MR imaging showed no significant association with recurrent septic arthritis of the shoulder.
使用多变量分析研究术后复发性肩脓毒性关节炎（SAS）的临床和影像学预测因素。
回顾性纳入 2011 年 1 月至 2019 年 10 月期间因 SAS 接受手术的 43 例患者（平均年龄 65 岁，24 例女性）。一名骨科医生评估了临床（年龄、性别、合并症、从症状出现到 MRI 和手术的时间、手术方法、抗生素使用情况）、实验室（血清白细胞计数、C 反应蛋白水平、滑液细胞计数）和手术发现（培养/活检结果）。两名肌肉骨骼放射科医生评估了 MRI 结果（骨髓[反应性骨髓水肿、骨髓炎、骨软骨侵蚀]和软组织[滑膜炎、滑囊炎、肌肉水肿、脓肿]异常）。术后≥12 个月时评估复发性 SAS。进行单变量和多变量分析以确定复发性 SAS 的最佳预测因素。
总体复发性 SAS 发生率为 33%（43 例中有 14 例）。在单变量分析中，平均年龄（无复发 vs. 复发：68 岁 vs. 59 岁，p=0.04）、从症状出现到手术的平均时间（18 天 vs. 25 天，p=0.02）、血清白细胞计数（12,000 个细胞/ml vs. 9,000 个细胞/ml，p=0.04）、C 反应蛋白水平（13 毫克/L vs. 6 毫克/L，p=0.01）和 MRI 上的骨髓炎（两位读者均为 p<0.01）在无复发和复发患者之间差异显著；多变量分析显示，仅 MRI 上的骨髓炎与两位读者的复发性 SAS 显著相关（p=0.02 和 0.01）。除肌肉水肿外（中度，κ=0.37），所有 MRI 发现的观察者间一致性良好（κ=0.62-1.0）。
MRI 上的骨髓炎是复发性 SAS 的最佳预测因素。
