Summary

Needle arthroscopy promises to be an efficient treatment at the patient's bedside for patients with a clinical suspicion of bacterial arthritis of a native joint.

Abstract

Introduction

For patients with bacterial arthritis, recent technological innovation offers the possibility of a 2-mm diameter bedside arthroscopic lavage, also known as needle arthroscopy. This might prevent patients from having to undergo surgery in the expensive operation theater. Consequently, the primary objective of this study was to evaluate the effectiveness (in terms of avoiding additional interventions to control the infection) of immediate bedside needle arthroscopy under local anesthesia in patients with suspected bacterial arthritis of a native joint.

Methods

In this multicenter, prospective cohort study, we included all adult patients with clinical suspicion of bacterial arthritis of a native joint (i.e. shoulder, elbow, wrist, knee, and ankle). We excluded patients with a foreign body in the affected joint, recent fracture surgery with arthrotomy, acute traumatic open joint fracture, and local osteomyelitis. All procedures were performed under local anesthesia at the patient's bedside in the emergency department, inpatient ward, or outpatient clinic. The primary outcome was the number of patients that needed additional intervention (s) to control the infection of the affected joint <30 days.

Results

A total of 30 joints (28 patients) were included and managed with needle arthroscopy. The mean age was 65 years (ranging from 21 to 101 years) and eight patients were female. There were 21 knees, five ankles, two elbows and two shoulders included. Five patients (17%) needed an additional intervention for successful management of the infection. Three of these patients (10%) needed an additional operation (i.e. conventional arthroscopy or arthrotomy) and two patients (7%) recieved an additional arthocenthesis. The mean numeric rating scale (NRS) for maximum pain during the intervention was 4.4 and conversion to general or spinal anesthesia was not required. A satisfactory clinical outcome was seen at the 3-month follow-up, with no mortality and major surgeries (e.g. prosthesis).

Conclusion

In-office needle arthroscopy promises to be an efficient treatment at the patient's bedside for patients with a clinical suspicion of bacterial arthritis of a native joint. In this series, 90% of the patients were saved a trip to the operation theater for conventional expensive surgery, without compromising clinical outcomes.