Summary

Arthroscopic irrigation and debridement for glenohumeral septic arthritis is as effective as arthrotomy in eradicating infection, with lower overall adverse events and comparable reinfection rates, mortality rates, and length of hospital stay.

Abstract

Comparison of open arthrotomy and arthroscopic irrigation for glenohumeral septic arthritis: A systematic review and meta-analysis

Introduction

Glenohumeral joint septic arthritis is an uncommon condition that can result in local destruction of the articular cartilage and systemic infection. Joint irrigation and debridement is an effective treatment for septic arthritis and can be performed either via an arthrotomy or arthroscopically. Whilst arthroscopic irrigation and debridement has been established to be effective in various native joint septic arthritis, consensus has yet to be established for glenohumeral septic arthritis. This systematic review and meta-analysis aims to evaluate the efficacy of arthroscopy and arthrotomy in the treatment of glenohumeral septic arthritis.

Methods

PubMed, Embase and Medline were searched from inception to 28 August 2024 for articles comparing arthroscopy and arthrotomy in the treatment of native glenohumeral septic arthritis. Two blinded authors sieved through the abstract in two phases (title abstract and full text), the primary outcome was reinfection or reoperation rates. Secondary outcomes of interest include mortality rates, length of hospital stay and overall adverse events. A comparative meta-analysis was conducted between arthroscopy and arthrotomy where odds ratio (OR) and mean difference (MD) were estimated for dichotomous and continuous variables respectively, using the DerSimonian and Liard random effects model. Heterogeneity was assessed using the I2 and Cochrane Q test. A p-value of < 0.05 was deemed statistically significant.

Results

A total of 1,501 articles were returned from the search with 1,137 articles remaining after removal of duplicates. Eventually, a total of 9 articles including 10,352 patients with the diagnosis of glenohumeral septic arthritis were evaluated, with 4,250 patients in the arthroscopic debridement arm and 6,102 patients in the open debridement arm. The age of participants in the arthroscopy and arthrotomy group were mean (standard deviation) 63.2 (16.3) years and 60.9 (18.7) years respectively, while follow up duration in the studies ranged between 30 days to 32 months. Comparative analysis revealed that both arthroscopy and arthrotomy performed similarly in terms of reinfection rates (odds ratio [OR], 0.97 [95% CI, 0.66-1.43]; p=0.876). However, a lower risk of overall adverse events was observed in the arthroscopy group as compared to arthrotomy group (OR, 0.73 [95% CI, 0.54-0.99]; p=0.045), in a subset of 922 patients. Comparable lengths of hospital stay (MD, -0.55 days [95% CI, -1.57–0.48]; p=0.295) and mortality rates (OR, 1.01 [95% CI, 0.72-1.40]; p=0.076) were observed between both groups.

Conclusion

Arthroscopic irrigation and debridement for glenohumeral septic arthritis is as effective as arthrotomy in eradicating infection. Current evidence suggests lower overall adverse events in glenohumeral septic arthritis treated arthroscopically with comparable reinfection rates, mortality rates and length of hospitalisation. Further studies are warranted to explore long term post-operative functional outcomes after either surgical approach.