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Septic knee arthritis following joint injections: myth or reality? 16 years retrospective study in a multi-specialist hospital
ESSKA Academy. Manzotti A. Nov 8, 2019; 286348; epEKA-16 Topic: Open Surgery
Dr. Alfonso Manzotti
Dr. Alfonso Manzotti
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Abstract
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Introduction: Septic arthritis is an infrequent but potentially catastrophic evenience, which can also be caused even by intra-articular therapeutic infiltration. In both orthopedic and reumatologic practice numerous substances have been recommend for intra-articular injection with an overall septic complication incidence of less than 5 cases for every 10,000 infiltrations. The aim of the Authors is to present a 16-years follow-up retrospective study performed in a a regional infectious reference center based in a multi-specialist hospital assessing its own experience in managing septic knee arthritis following intra-articular injections
Material and methods: In Our istitution from 2002 to 2018, were referred 11 cases of acute septic knee arthritis following joint therapeutic infiltrations. Demographic data with patient age, sex, comorbities, and type of infiltration were documented. Likewise responsible pathogens, when identified, both antibiotic therapy and surgical treatment including number of procedures and final outcome were registered.
Results: Patients mean age was 68 years (range: 54-83) with 7 males and 4 females. In one case the infection arose after an infiltration with autologous platelet concentrate (knee), in 3 cases with hyaluronic acid and in 7 cases after infiltration with steroids. In 3 cases it was not possible to isolate any germ, in 6 cases the responsible agent was an MSSA, in 3 cases an MRSA and in one case a pseudomonas aeruginosa. The most frequently associated pathologies were insulin dependent diabetes or autoimmune diseases such as arthritis rheumatoid. Surgical treatments ranged from arthroscopic procedures (early treatments) to more invasive open surgical procedures in late treatments.
Discussion: This study present one of the largest series of septic knee arthritis following intrarticular injections described in the literature by a single center. The results confirm that post infiltrative septic knee arthritis could be a devastating complication requiring significant costs and sometimes with poor outcomes. It is essential to identify patients at risk and implement infiltrative procedures in the absolute sterility. The authors underline the importance of early diagnosis to obtain good results with relatively less invasive surgical treatment. Luigi Sacco' Hospital Milan confirmed Luigi Sacco' Hospital, Orthop. and Trauma dept, Milan, Italy
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