Linden Gabriel S, Lipson Sophie E, Desai Vineet, Krivicich Laura M, Puzzitiello Richard N, Gabriel Daniel, Alswang Jared M, Wurcel Alysse G, Ryan Scott P, Chen Antonia F, Salzler Matthew J
Tufts University School of Medicine, Boston, MA, USA.
Tufts Medical Center, Department of Orthopaedics, Boston, MA, USA.
J Orthop. 2024 Nov 12;64:18-22. doi: 10.1016/j.jor.2024.11.006. eCollection 2025 Jun.
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.
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.
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.
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.
化脓性关节炎是一种骨科急症，需要及时进行冲洗清创术（I&D）。一些患者需要重复进行冲洗清创术，这给患者和医护人员带来了沉重负担。本研究的目的是确定原发性化脓性关节炎患者重复进行冲洗清创术的可能危险因素。
通过计费代码回顾性确定2014年6月至2018年11月在两家一级创伤中心初诊为原发性关节化脓性关节炎的连续患者。临床表现符合原发性化脓性关节炎的患者纳入研究。采用独立样本t检验、Fisher精确检验和多变量逻辑回归分析来确定哪些重复冲洗清创术的危险因素具有统计学意义。
共确定221例患者，192例纳入最终分析（女性36%，男性64%，平均年龄53岁）。分析包括231个关节（膝关节115个，髋关节53个，肩关节37个，其他关节16个）。29%的化脓性关节与注射吸毒相关（IDU-SA）。30%的IDU-SA病例需要重复进行冲洗清创术，而非IDU-SA病例为17%（p = 0.03）。与非IDU-SA患者相比，IDU-SA患者的冲洗清创术总数更多（1.70比1.32；p = 0.048）。在控制吸烟史、糖尿病、人类免疫缺陷病毒、免疫功能低下状态和类固醇使用后，这种关联仍然显著。
IDU-SA与重复冲洗清创术相关。治疗IDU-SA患者的医生应改变术后监测标准，并考虑采用多模式团队方法来改善化脓性关节炎的管理。
