Introduction
Most patients are effectevly managed with a single surgical debridement of a bacterial native joint arthritis, but some cases may require more than one debridement to control the infection. Consequently, this systematic review aims to assess the failure rate (i.e. reintervention rate) of a single surgical debridement in adults with bacterial arthritis of a native joint. Additionally, risk factors for failure were assessed.
Materials And Methods
PubMed, Embase, and Cochrane libraries were systematically searched between January 1980 and January 2021 to identify articles including adult patients reporting on the incidence of failure (i.e. persistence of infection requiring reoperation) of the treatment of bacterial arthritis of a native joint. The quality of individual evidence and risk of bias were assessed using the Quality in Prognosis Studies (QUIPS) tool. The failure rates of a single surgical debridement were extracted from included studies and pooled. Risk factors for failure were extracted and grouped. Moreover, we evaluated which risk factors were significantly associated with failure.
Results
Thirty studies (8,586 native joints) were included in the final analysis. The overall pooled failure rate was 26% (95% CI 20 to 32%). The failure rate of arthroscopy and arthrotomy was 26% (95% CI 19 to 34%) and 24% (95% CI 17 to 33%), respectively. Seventy-nine potential risk factors for failure were extracted and grouped. Moderate evidence was found for one risk factor (synovial white blood cell count), and limited evidence was found for five risk factors (i.e. sepsis, large joint infection, the volume of irrigation, blood urea nitrogen-test, and blood urea nitrogen/creatinine ratio).
Conclusion
A single surgical debridement fails to control bacterial arthritis of a native joint in approximately a quarter of all adult cases. No difference in failure rates was found between arthroscopy and arthrotomy. Limited to moderate evidence exists that risk factors associated with failure are: synovial white blood cell count, sepsis, large joint infection, the volume of irrigation, blood urea nitrogen test, and blood urea nitrogen/creatinine ratio. These factors should urge physicians to be especially receptive to signs of an adverse clinical course.