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International Orthopaedics
Published in: International Orthopaedics 1/2018

01-01-2018 | Original Paper

Septic arthritis associated with systemic sepsis

Authors: Sung-Weon Jung, Dong-Hee Kim, Sung-Jin Shin, Byoung-Youl Kang, Yil-Ju Eho, Seong-Wook Yang

Published in: International Orthopaedics | Issue 1/2018

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Abstract

Purpose

Septic arthritis presents with good joint function, but sometimes leads to poor outcomes. Concurrent systemic sepsis has been regarded as the poor outcome, and the exact cause remains unclear. This paper was performed to identify factors associated with concurrent systemic sepsis and to research results to predict poor outcomes in patients with septic arthritis.

Methods

Laboratory and medical data were reviewed for 137 adults with acute septic arthritis who underwent open or arthroscopic surgical debridement at our institution between January 2005 and December 2014. The patients were divided according to whether they had septic arthritis alone (Group A) or in combination with systemic sepsis (Group B). Systemic sepsis was defined as two more systemic inflammatory signs in response to an infectious process. Patient characteristics, laboratory findings, synovial fluid findings and cultures, and surgical results were compared between two groups.

Results

Of the 137 patients, 41 (29.9%) had initial systemic sepsis at the diagnosis of septic arthritis. Independent t test revealed that duration of prodromal symptom (p = 0.012), serum neutrophil percent (p = 0.008), C-reactive protein (p = 0.001), Charlson comorbidity index (p = 0.001), positive culture in synovial fluid (p = 0.001), and methicillin-sensitive Staphylococcus aureus (MSSA) isolate in synovial fluid (p = 0.001) had significant correlations with the group B. Repeated debridement was performed for those who had recurrence of infection, and this procedure was more often in group B (23 versus 21 joints, 23.9 versus 51.2%, p = 0.012). Progression of arthritis occurred more often in group B (16 versus 17 joints, 16.7 versus 41.5%, p = 0.001).

Conclusion

Septic arthritis combined with systemic sepsis was related to duration of prodromal symptom, serum neutrophil percent, C-reactive protein, Charlson comorbidity index, positive culture in synovial fluid, and a MSSA isolate in synovial fluid. Concurrent systemic sepsis led to poor outcomes in patients with septic arthritis in terms of recurrence of infection and progression of arthritis.
Level of Evidence: III Case control study
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Metadata
Title
Septic arthritis associated with systemic sepsis
Authors
Sung-Weon Jung
Dong-Hee Kim
Sung-Jin Shin
Byoung-Youl Kang
Yil-Ju Eho
Seong-Wook Yang
Publication date
01-01-2018
Publisher
Springer Berlin Heidelberg
Published in
International Orthopaedics / Issue 1/2018
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI
https://doi.org/10.1007/s00264-017-3565-4

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