Injection drug use is associated with repeat irrigation and debridement in native joint septic arthritis.

BACKGROUND AND OBJECTIVE

Septic arthritis is an orthopaedic emergency that requires prompt irrigation and debridement (I&D). Some patients require a repeat I&D, which poses excessive burden on the patient and provider. The goal of this study was to identify possible risk factors for repeat I&D in the setting of native septic arthritis.

MATERIALS AND METHODS

Consecutive patients with a primary diagnosis of native joint septic arthritis from June 2014-November 2018 at two level-one trauma centers were retrospectively identified via billing codes. Patients were included if they had a clinical presentation consistent with native septic arthritis. Independent-sample T-tests, Fisher's Exact Tests, and multivariable logistic regression were performed to determine what risk factors for repeat I&D were statistically significant.

RESULTS

Two-hundred and twenty-one patients were identified, and 192 were included in the final analysis (36 % female, 64 % male, mean age 53 years). 231 joints were included in the analysis (knee, n = 115; hip, n = 53; shoulder, n = 37; other, n = 16). 29 % of septic joints were associated with injection drug use (IDU-SA). 30 % of IDU-SA cases required a repeat I&D compared to 17 % for non IDU-SA cases (p = 0.03). IDU-SA patients were associated with more total I&Ds compared to patients without IDU-SA (1.70 vs. 1.32; p = 0.048). This association remained significant when controlling for smoking history, diabetes, human immunodeficiency virus, immunocompromised status, and steroid use.

CONCLUSIONS

IDU-SA was associated with repeat I&D. Physicians working with IDU-SA patients should alter postoperative surveillance standards and consider adopting a multimodal team approach to improve septic arthritis management.