gms | German Medical Science

Objectives/Interrogation: Septic arthritis is a potentially joint destructing condition if not treated properly, and septic arthritis of the wrist accounts for an estimated 5% of septic arthritis of all joints.

Arthroscopic lavage is a well established treatment for septic arthritis of the knee, hip or shoulder. However, previous studies on treatment of wrist arthroscopy were limited to case reports or retrospective studies focusing on open treatment. There is also insufficient data on functional outcome following treatment. Our study aims to establish the effectiveness of arthroscopic treatment and to investigate the functional outcome.

Methods: This is a retrospective study reviewing all cases of septic arthritis of the wrist treated by arthroscopic lavage over a period of 10 years from 2007 to 2016. Clinical data collected included age, gender, history of prior injury, duration of symptoms, culture of joint aspirate, and radiological findings.

An arthroscopic technique and any additional procedures performed are described. Intraoperative findings, duration and type of antibiotics used, number of operations performed, and length of hospital stay were reviewed.

Functional outcomes included range of motion and subjective evaluation with QuickDASH (Disabilities of the Arm, Shoulder, and Hand) score questionnaire.

Results and Conclusions: From 2007-2016, 14 patients (10 males and 4 females) with 15 septic wrists underwent arthroscopic surgery. One patient had both wrists involved. The average age at time of operation was 63.9 years old and the average duration of symptoms before admission was 6.08 days. Average follow up time was 10 months.

The most notable risk factors were diabetes mellitus and mmunosuppression conditions which were present in 8 patients. All except 2 patients (83.3%) responded well to single arthroscopic treatment. Two required subsequent operations for concomitant tenosynovitis. There were no complications. The most common isolated organism was staphylococcus aureus. At an average follow up of 10 months, one case (8.3%) had signs of severe joint erosion on subsequent X-Ray. The average QuickDASH score was 19.7 out of 100. Duration of symptoms of 5 days or more prior to presentation was associated with a poorer QuickDASH score.

With a low re-operation rate and good functional outcome which is comparable to open treatment from previous studies, arthroscopic treatment is a safe and effective alternative to open procedure as a first-line treatment for septic arthritis of the wrist.