Acute Septic Arthritis Following Joint Injections

Resumen

Introduction

Septic arthritis is an infrequent but potentially catastrophic evenience, which can also be caused even by intra-articular therapeutic infiltration. In both orthopedic and reumatologic practice numerous substances have been recommend for intra-articular injection: either steroids, anesthetics, hyaluronic acid or autologous substances such as mesenchymal cells and platelet concentrates or gaseous substances such as ozonewith an overall septic complication incidence of less than 5 cases for every 10,000 infiltrations

AIM:

The aim of the Authors is to present a 10-years follow-up retrospective Study performed in a a regional hospital center.

Method

Patients with diagnosis of septic arthritis following joint injections,treated in our hospital from 2010 to 2021 were included in the study. Only patients receiving an intra-articular infiltration within 2 weeks before clear clinical signs suspicious for septic arthritis were considered eligible for the study. We included in the study 17 cases affected by septic arthritis involving different joints following joint injections. Demographic data with patient age, sex, comorbities, and type of infiltration were documented. Likewise responsible pathogens, when identified, both antibiotic therapy and surgical treatment, number of procedures and final outcome were registered. Early and late treatments were classified accorging to the time occurred betwen sepsis diagnosis and treatment.

Results

We collected 17 patients with septic arthritis post-infiltration in multiple articulations. The mean age was 72 years old (range:52-84), 12 males, 5 females, with a predominance in males (70.5 %). Joint involved was knee in 11 cases , 6 shoulders. Septic arthritis occurred mainly following corticosteroids injections in 11 cases (64.7%), followed by hyaluronic acid 6 cases. The pathogen more often isolated was Staphylococcus Aureus in 11 cases (64.7%), mostly MSSA strain,Pseudomonas Aeruginosa in 1 case and no isolation of bacteria in 5 cases. The mean pre operative Charlson Comorbidity Index was 3,8 and we identified and there were 3 patients belonging to class A, 10 patients to class B and 4 patients to class C in Cierny-Mader classification. The most frequently associated pathologies were insulin dependent diabetes or autoimmune diseases such as arthritis rheumatoid. All the patients underwent to a surgical procedure. 8 patients (64%) ad a complete resolution following an arthroscopic debridement, 9 patients underwent to a open debridement.

Conclusion

This study present an largest series of septic knee arthritis following intrarticular injections. The results confirm that post infiltrative septic knee arthritis could be a devastating complication requiring significant costs and sometimes with poor outcomes. It is essential to identify patients at risk and implement infiltrative procedures in the absolute protection of sterility. We observed a direct correlation between poor health/immunological condition and required surgical procedures to solve this complication and we recommend an early arthroscopic debridement especially in knee involvement. On this purpose the authors advocated that this patients should be treated in a multispecialistic dedicated environment.