Septic arthritis surgical management: Difference between revisions
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! rowspan="2" |Needle aspiration | ! rowspan="2" |Needle aspiration | ||
!Closed needle aspiration | !Closed needle aspiration | ||
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* Best initial surgical option if joint is easily accessible such as peripheral joints. ( e.g. Knee, ankle, elbow and wrist etc.) | * Best initial surgical option if joint is easily accessible such as peripheral joints. ( e.g. Knee, ankle, elbow and wrist etc.) | ||
* Very accessible to remove large amount of purulent synovial fluid unless there is presence of negative prognostic factors such as: | * Very accessible to remove large amount of purulent synovial fluid unless there is presence of negative prognostic factors such as: | ||
| Line 28: | Line 28: | ||
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!Open drainage | !Open drainage | ||
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* Open drainage is useful in patients with inaccessible joint involvement such as axial joints (e.g. hip, shoulder and sternoclavicular | * Open drainage is useful in patients with inaccessible joint involvement such as axial joints (e.g. hip, shoulder and sternoclavicular joint | ||
joint | |||
* Useful in persistent joint infections ( > 7 days) | * Useful in persistent joint infections ( > 7 days) | ||
|- | |- | ||
! colspan="2" |Tidal irrigation | ! colspan="2" |Tidal irrigation | ||
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* Bed side procedure and effective as arthroscopy | * Bed side procedure and effective as arthroscopy | ||
* It is a closed-system irrigation method may be useful in: | * It is a closed-system irrigation method may be useful in: | ||
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! colspan="2" |Arthroscopic lavage | ! colspan="2" |Arthroscopic lavage | ||
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* Useful in persistent joint infections ( >7 days) | * Useful in persistent joint infections ( >7 days) | ||
* Best effect seen in patients with deep joint involvement such as hip with loculations or abscesses | * Best effect seen in patients with deep joint involvement such as hip with loculations or abscesses | ||
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! colspan="2" |Arthrotomy | ! colspan="2" |Arthrotomy | ||
|Arthrotomy best useful in: | |||
* Patients with increased risk of neuropathy or compromised blood supply when infected joint is not accessible with less invasive methods. Joint decompression with arthrotomy will reduce these complications | * Patients with increased risk of neuropathy or compromised blood supply when infected joint is not accessible with less invasive methods. Joint decompression with arthrotomy will reduce these complications | ||
* When the infected pathogen is confirmed as Pseudomonas to reduce oxygen tension and PH in infected joint. | * When the infected pathogen is confirmed as Pseudomonas to reduce oxygen tension and PH in infected joint. | ||
Revision as of 16:30, 24 January 2017
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Septic arthritis Microchapters |
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Septic arthritis surgical management On the Web |
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American Roentgen Ray Society Images of Septic arthritis surgical management |
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Risk calculators and risk factors for Septic arthritis surgical management |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Venkata Sivakrishna Kumar Pulivarthi M.B.B.S [2]
Overview
Surgical management options include:
- Needle aspiration
- Closed needle aspiration
- Open drainage
- Tidal irrigation
- Arthroscopy
- Arthrotomy
There is no specific guidelines for the surgical management but the efficacy of the surgical treatment depends on the clinical condition of the patient.
| Surgical management option | Description | |
|---|---|---|
| Needle aspiration | Closed needle aspiration |
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| Open drainage |
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| Tidal irrigation |
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| Arthroscopic lavage |
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| Arthrotomy | Arthrotomy best useful in:
| |
As the volume of synovial fluid, the cell count, and the % of polymorphonuclear leukocytes decrease with each aspiration, it is advisable to switch to combination therapy with both antibiotics and needle aspiration whenever needed.