Background: Nineteen patients with septic arthritis of the
glenohumeral joint were treated with a combination of arthroscopic irrigation
and débridement and systemic antibiotics according to bacterial
sensitivity. We retrospectively reviewed the series to determine the efficacy
and safety of this treatment.
Methods: There were seventeen men and two women, with a mean age of
fifty-nine years. Underlying medical disease was present in thirteen patients,
with six of them having diabetes. The average duration of symptoms prior to
the arthroscopic lavage was three weeks. Fifteen patients had had local
injections into the shoulder joint. The arthroscopic staging of the infection
was based on the modified criteria of Gächter. The functional outcome was
evaluated with use of the UCLA scoring system.
Results: As determined at arthroscopy, one infection was classified
as stage I; seven, as stage II; nine, as stage III; and two, as stage IV.
Staphylococcus was the most common organism identified. The infection was
eradicated completely with a single arthroscopic procedure in fourteen
patients. The mean UCLA score at the time of the last follow-up was 26 points,
with a mean score of 23.7 points for the eleven patients with a rotator cuff
tear and 29 points for the eight with an intact rotator cuff. Patients who had
had symptoms for no more than two weeks prior to the arthroscopic lavage had
better results than those who had had symptoms for longer than two weeks.
Conclusions: Arthroscopic débridement for the treatment of
septic arthritis of the shoulder is safe and efficient, particularly in the
early stages of the disease. Underlying medical diseases such as diabetes,
prior injections, or a preexisting rotator cuff tear were seen in a high
proportion of these patients.
Level of Evidence: Therapeutic Level IV. See Instructions
to Authors for a complete description of levels of evidence.