Volume 6, Number 11;  July 20, 2006

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Unique Identifier [PMID]: 15356433

Authors: Manadan AM. Block JA.

Institution: Section of Rheumatology, Rush Medical College, Rush-Presbyterian--St. Luke's Medical Center, Chicago, IL 60612, USA. amanadan@rush.edu

Title: Daily needle aspiration versus surgical lavage for the treatment of bacterial septic arthritis in adults. [Review] [13 refs]

Source: American Journal of Therapeutics. 11(5):412-5, 2004 Sep-Oct.

Abstract: Septic arthritis is a substantial public health problem, accounting for 0.2-0.7% of hospital admissions. However, despite the availability of effective antibiotics, the appropriate approach to adjunctive therapy remains controversial. Although early drainage is essential to minimize the risks of permanent loss of articular function, it is unclear whether the optimal approach involves arthroscopic lavage or daily arthrocentesis; surgeons appear to prefer surgical lavage because their training routinely considers septic arthritis to be a closed-space infection comparable to an abscess, whereas rheumatologists appear to prefer daily arthrocentesis because of its ease and non-invasive nature. There is a paucity of prospective data comparing the two approaches, and the literature is largely retrospective. Herein, we review the available literature concerning drainage of bacterially infected joints, and conclude that in the absence of prospective randomized clinical trials, the best evidence suggests that there is no compelling reason to recommend surgical lavage for the initial management of uncomplicated septic arthritis. [References: 13]

Publication Type: Journal Article. Review.

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Unique Identifier [PMID]: 3542355

Authors: Broy SB. Schmid FR.

Title: A comparison of medical drainage (needle aspiration) and surgical drainage (arthrotomy or arthroscopy) in the initial treatment of infected joints. [Review] [120 refs]

Source: Clinics in Rheumatic Diseases. 12(2):501-22, 1986 Aug.

Abstract: Acute infectious arthritis remains a clinical emergency where early diagnosis and appropriate therapy are essential to a successful outcome. The therapeutic requirements for a successful outcome include early diagnosis, appropriate antibiotics, joint mobilization and adequate drainage. The method of drainage can be medical with needle aspiration or surgical with arthroscopic or open surgical debridement. The literature review presented in this chapter supports the value of the initial use of medical therapy in the management of the acutely infected joint, with surgical drainage reserved for failure of medical management or for initial drainage of hip infections where needle aspiration is difficult. [References: 120]

Publication Type: Journal Article. Review.

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Unique Identifier [PMID]: 7123295

Authors: Bynum DK Jr. Nunley JA. Goldner JL. Martinez S.

Title: Pyogenic arthritis: emphasis on the need for surgical drainage of the infected joint.

Source: Southern Medical Journal. 75(10):1232-5, 1238, 1982 Oct.

Abstract: A ten-year retrospective review of patients with acute hematogenous pyogenic arthritis at the Duke University Medical Center yielded 14 affected joints in the pediatric group and 32 in adults. Follow-up ranged from six months to eight years. Analysis of factors possibly affecting end results included the joint involved, organism, duration of infection, antibiotics used, age of the patient, and mode of drainage--whether surgical or by needle aspiration. Surgical drainage in the pediatric group yielded uniformly excellent results. In adults, needle aspiration correlated with increased mortality and morbidity. In contrast to other series in the medical literature we found the indications for needle aspiration to be highly restrictive, and we recommend surgical drainage and appropriate antibiotics as the treatment of choice for most patients with pyogenic arthritis.

Publication Type: Journal Article.

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Unique Identifier [PMID]: 1115748

Authors: Goldenberg DL. Brandt KD. Cohen AS. Cathcart ES.

Title: Treatment of septic arthritis: comparison of needle aspiration and surgery as initial modes of joint drainage.

Source: Arthritis & Rheumatism. 18(1):83-90, 1975 Jan-Feb.

Abstract: Surgery and needle aspiraton have been evaluated as initial modes of drainage in 59 patients with acute septic arthritis. Full recovery was noted in 42% treated surgically at the outset. On the other hand, 67% of those treated by needle aspiration recovered without sequelae, despite the greater prevalence in this group of adverse host factor-eg, serious underlying illness, concommitant extraarticular infection, prior arthritis in the infected joint, and recent antibiotic or immunosuppressive therapy.

Publication Type: Journal Article.

Resident Report / Department of Medicine & Grady Branch Library

Emory University School of Medicine

2006 Edition

Participating Faculty:  Carlos Del Rio MD  / Joyce Doyle MD / Lorenzo Difrancesco MD / Joel Mermis MD / Maunank Shah MD

Contact: Karl Woodworth