Post-operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts

Purpose: Septic arthritis is a significant complication following arthroscopic surgery with an estimated overall incidence of less than 1%. Despite the low incidence, a suitable diagnostic and therapeutic approach is required to avoid serious long-term consequences, to eradicate the infection and to ensure good treatment results. The aim of this current review article is to summarize evidence-based literature on diagnostic and therapeutic options for postoperative septic arthritis after arthroscopy.

Methods: Current treatment algorithms and therapies were identified through a literature search. In addition, a supporting new algorithm for the diagnosis and treatment of suspected septic arthritis after arthroscopic surgery is proposed.

Results: A major diagnostic challenge is that the differentiation of the postoperative status between an uninfected hyperinflammatory joint and septic arthritis based on clinical symptoms (e.g. rubor, calor or tumor) can appear identical. Therefore, a joint puncture is recommended for microbiological evaluation, especially for rapid diagnosis of the white blood cell count. A cell count of more than 20,000 leukocytes / µl with more than 70% polymorphonuclear cells is the generally accepted threshold for septic arthritis.

Conclusion: The therapy is based on arthroscopic or open surgical debridement for synovectomy and flushing of the joint in combination with adequate antibiotic therapy for 6-12 weeks. In chronic cases, it is recommended that indwelling accessories such as interference screws for ACL repair or anchors for rotator cuff repair be removed.

Evidence level: IV.

Keywords: Ankle; Antibiotics; Arthroscopy; Complication; Elbow; Hip; Joint infection; Knee; Shoulder; Wrist.