In only 23 patients was immediate incision and surgical drainage performed with debridement of the hip joint, and removal of the panus on the cartilage. The length of the follow up was 7—16 years.
Septic arthritis in children
The hips were classified according to radiographic findings into 3 groups. The evaluation and analysis of the results revealed primarily that delay in diagnosis lead to delayed treatment particularly in neonates and infants. Other factors which have an unfavorable outcome in the pyogenic hip arthritis are the multiple location, osteomyelitis of the hip region and the causative organism. Rapid diagnosis followed by immediate aspiration with surgical drainage and early administration of an appropriate antibiotics lead to good or excellent results.
Joint Replacement Infection - OrthoInfo - AAOS
Single-centre retrospective cohort study from to Electronic records were reviewed for demographic, clinical, laboratory, treatment and outcome data. Total and hemi-arthroplasty infections were excluded. A median of 1 surgical procedure was undertaken during treatment.
This is the largest series of adult native joint septic arthritis currently available. Small joint infection, often excluded from previous studies, is associated with significantly better outcomes than large-joint infection.
The physical examination shows shoulder asymmetry with an increase in volume from the deltoid region to the middle third of the right clavicle Fig. Lab tests: leukocytes: 16, mm 3 , neutrophils: Left: Acromioclavicular space of 1. No bone lesion data.. Comparative shoulder X-rays: a Right shoulder X-ray: volume increase in soft tissues, with radiolucent images compatible with subcutaneous emphysema; irregular acromioclavicular bone edges, right acromioclavicular joint 9. Intravenous antibiotic therapy initiated with 1 g of Ceftriaxone every 12 h and mg of clindamycin every 8 h.
Arthrotomy on the right acromioclavicular joint, surgical lavage and debridement were performed Fig. Culture report: Streptococcus agalactie.. The same antibiotic regimen was continued for proper evolution until completion at the end of the 10 days. Discharged with oral antibiotic mg ciprofloxacin orally every 8 h and mg clindamycin every 8 h for 4 weeks..
Follow-up 2 weeks after surgery, asymptomatic. The last control was at 9 months where the X-ray showed a lytic acromioclavicular space of 11 mm and full range of motion in the right shoulder Fig. This is a rare pathology given the limited space and characteristics of the joint, and may even be underdiagnosed because it is not easy to distinguish a septic glenohumeral disorder from a simple physical examination.
In addition, it must be differentiated from traumatic synovitis, abscesses, acute rheumatic fever, joint infection due to microbacteria, cellulitis, acute osteomyelitis and haemophilia. Septic arthritis of the acromioclavicular joint tends to appear in immunocompromised patients, either infected with HIV, rheumatoid arthritis, renal insufficiency, multiple myeloma, chronic steroid use, hepatic cirrhosis 2,8 ; as well as a history of venipuncture, local trauma, articular puncture, prior shoulder surgery, septic arthritis in another joint, periprosthetic infections and ulcers on diabetic feet.
The patient being studied had a history of chronic evolution as an insulin-dependent diabetic, who did not adhere well to treatment and did not use glucose-lowering drugs for 1 week prior to his admission. He also presented with plantar infections 6 and 12 months prior.. It is described that in the absence of trauma and articular manipulation, septic arthritis must be considered a consequence of haematogenous dissemination, 8,9 as is likely in the case of our patient.. The vast majority were previously treated with analgesics and anti-inflammatories, as in this case, leading to the delay in diagnosis and treatment 15 days after onset..
Chronic cases are attributed to microbacteria and can take up to a year to diagnose. Image studies are very useful for diagnosis.. A simple X-ray of the shoulder does not usually reveal bone changes in the initial stages, 6,9,12 however, it is an easy, inexpensive, and quick study that does not merit patient preparation, is not user-dependent and provides a lot of data, both positive and negative, as in this case, where upon admittance, he already presented with changes that were very suggestive of the pathology and vital for regulating treatment..
Ultrasound is a tool for the early diagnosis and treatment of septic arthritis of the acromioclavicular joint, 12 it can detect an increase in echogenicity, distension of the joint cavity, bone irregularity, as well as guiding punctures, similarly, septic arthritis of the acromioclavicular joint can be ruled out if the joint space is less than 3 mm.
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- Approach to Septic Arthritis?
Magnetic resonance imaging MRI can detect septic joint changes in the first 24 h of onset, 8 changes compatible with oedema, joint effusion, thickening of the cartilage and, as with ultrasound, septic arthritis of the acromioclavicular joint can be ruled out if the joint space is less than 3 mm in a coronal cut. A firm suspicion, knowledge of the pathology and a focused physical examination are vital for diagnosing septic arthritis of the acromioclavicular joint 2 and tests such as MRI and ultrasound may not always be available. Antibiotic treatment should initially be empirical and focus on the most common causal agent S.
Endogenous factors such as diabetes alter the normal composition of the intestinal microbiota; these factors can partly explain why GBS is a significant cause of infection in soft tissues and the urinary tract, of sepsis and arthritis in patients with chronic disorders. In the published literature, we find only the case of a patient with bilateral septic arthritis of the acromioclavicular joints, septic arthritis in the left hip and right knee with a history of CRI, skin lesion and abscess, treated intravenously with Penicillin G Sodium, oral amoxicillin and surgical debridement.
Kyu Cheol Noh et al. We consider that septic arthritis is an orthopaedic surgical emergency, and should be treated as such. The proteolytic enzymes of the leukocytes are released in the joint, which leads to the destruction of cartilage and irreversible joint damage in 48 h.
The small size of the acromioclavicular joint is associated with a high risk of local spreading and more rapid destruction of the joint, as well as the potential danger of subsequent infection of the glenohumeral joint; given that it commonly presents in immunocompromised patients, an early diagnosis should be made and surgical treatment provided immediately. The authors declare that no experiments were performed on humans or animals for this study..
The authors declare that no patient data appear in this article.. The authors declare that they have no conflict of interests.. ISSN: See more Follow us:.
Who's at Risk for Septic Arthritis?
Previous article Next article. Issue 4. Pages October - December Septic arthritis of the acromioclavicular joint due to Streptococcus agalactiae.
Case report. Reporte de caso. Download PDF. Fuentes-Nucamendi b , A. Corresponding author.