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
|
- 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:
- Delayed diagnosis , and chronic failure of less invasive methods to clear the infection
- Complicated joint involvement such as sternoclavicular joint,
- Extremes of age
- Chronic use of immunosuppressive drugs
- Presence of underlying joint diseases or juxtra-glomerular osteomyelitis
- Useful in repetitive drainage in the management of recurrent infections
|
| Open drainage
|
- Open drainage is useful in patients with inaccessible joint involvement such as axial joints (e.g. hip, shoulder and sternoclavicular joint
- Useful in persistent joint infections ( > 7 days)
|
| Tidal irrigation
|
- Bed side procedure and effective as arthroscopy
- It is a closed-system irrigation method may be useful in:
- when there is incomplete evacuation with needle aspiration
- When multiple synovial fluid samples demonstrate different characteristics
- When imaging studies demonstrating the presence of loculations inside the synovium
|
| Arthroscopic lavage
|
- Useful in persistent joint infections ( >7 days)
- Best effect seen in patients with deep joint involvement such as hip with loculations or abscesses
- Allows extensive debridement with small incision which allows rapid recovery
- It is less invasive than open drainage and more efficacious than needle aspiration in both drainage and visualization of the joint
|
| 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
- When the infected pathogen is confirmed as Pseudomonas to reduce oxygen tension and PH in infected joint.
- In patients with negative prognostic factors
|
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.
Surgical Management
References
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