J Wrist Surg 2020; 09(03): 190-196
DOI: 10.1055/s-0039-3402423
Scientific Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Functional Outcome for Arthroscopic Treatment of Septic Arthritis of the Wrist

Esther M. W. Chow
1   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
,
Jimmy K. Y. Lau
1   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
,
Lucci L. C. Liyeung
1   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
,
W. W. Chau
1   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
,
Michael C. K. Mak
1   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
,
W. L. Tse
1   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
,
P. C. Ho
1   Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Shatin, HKSAR, China
› Author Affiliations
Funding None.
Further Information

Publication History

22 September 2019

13 November 2019

Publication Date:
30 December 2019 (online)

Abstract

Background Septic arthritis is a potentially joint-destructing condition if not treated properly. Septic wrist accounts for ∼5% of all septic arthritis. Arthroscopic lavage is a well-documented treatment for septic arthritis of the knee, hip, or shoulder only. Previous studies on septic wrist were limited to case reports or retrospective studies focusing on open treatment, and functional outcome was seldom documented. Our study aims to evaluate the effectiveness of arthroscopic treatment and to investigate the functional outcome.

Materials and Methods Patients were retrospectively reviewed over a period of 10 years. Parameters including age, gender, history of prior injury, duration of symptoms, joint aspirates and intraoperative tissue culture, radiological and arthroscopic findings, antibiotics used, number of operations, and hospital stay were reviewed. Functional outcomes were evaluated with QuickDASH (disabilities of the arm, shoulder, and hand) score.

Results From 2007 to 2016, 14 patients (15 septic wrists) underwent arthroscopic surgery. One patient had bilateral involvement. The average age was 63.9 years and the average duration of symptoms was 6.08 days. Average follow-up time was 10 months. All except two patients (85.7%) responded to single arthroscopic treatment. Two required subsequent operations for concomitant tenosynovitis. There were no major complications. The most common isolated organism was Staphylococcus aureus. Only one case had severe joint erosion during follow-up. The average QuickDASH score was 19.7. Duration of symptoms 5 days or more before admission was associated with higher QuickDASH score (p = 0.04).

Conclusion Early arthroscopic treatment should be considered for all patients admitted for septic arthritis of the wrist if not contraindicated.

Level of Evidence This is a Level III, retrospective review.

 
  • References

  • 1 Mehta P, Schnall SB, Zalavras CG. Septic arthritis of the shoulder, elbow, and wrist. Clin Orthop Relat Res 2006; 451 (451) 42-45
  • 2 Rashkoff ES, Burkhalter WE, Mann RJ. Septic arthritis of the wrist. J Bone Joint Surg Am 1983; 65 (06) 824-828
  • 3 Jennings JD, Zielinski E, Tosti R, Ilyas AM. Septic arthritis of the wrist: incidence, risk factors, and predictors of infection. Orthopedics 2017; 40 (03) e526-e531
  • 4 Birman MV, Strauch RJ. Management of the septic wrist. J Hand Surg Am 2011; 36 (02) 324-326 , quiz 327
  • 5 Sammer DM, Shin AY. Arthroscopic management of septic arthritis of the wrist. Hand Clin 2011; 27 (03) 331-334
  • 6 Sammer DM, Shin AY. Comparison of arthroscopic and open treatment of septic arthritis of the wrist. J Bone Joint Surg Am 2009; 91 (06) 1387-1393
  • 7 Hariri A, Lebailly F, Zemirline A, Hendriks S, Facca S, Liverneaux P. Contribution of arthroscopy in case of septic appearance arthritis of the wrist: a nine cases series. Chir Main 2013; 32 (04) 240-244
  • 8 Hunter JG, Gross JM, Dahl JD, Amsdell SL, Gorczyca JT. Risk factors for failure of a single surgical debridement in adults with acute septic arthritis. J Bone Joint Surg Am 2015; 97 (07) 558-564