Guideline for management of septic arthritis in native joints (SANJO).

This clinical guideline is intended for use by orthopedic surgeons and physicians who care for patients with possible or documented septic arthritis of a native joint (SANJO). It includes evidence and opinion-based recommendations for the diagnosis and management of patients with SANJO.

Surgical therapy of extensive knee joint empyema: mid-term results after two-stage versus one-stage procedures.

PURPOSE: Untreated knee joint empyema leads to rapid destruction of the joint and, thus far, has proven challenging to treat. This study presents data obtained after one- versus two-stage surgical approaches. Specifically, clinical outcome, complication rate, re-infection rate, duration of operation, and hospital stay are reported. METHODS: Between 2006 and 2010, 67 patients with extensive knee joint empyema underwent surgical therapy. Patients underwent either a two-stage surgical approach with open joint treatment for 7-10 days or a one-stage procedure with primary closure of the knee joint after radical debridement. RESULTS: The two-stage procedure was performed on 36 patients, whereas the one-stage procedure was performed on 31 patients. Infection duration prior to the index procedure ranged from 3 days to 55 months (two-stage: ~5 months, one-stage: ~2.4 months). The groups did not differ significantly in demographic group characteristics. Hospital stay and duration of operation were significantly (p < 0.01) reduced in the one-stage group compared to the two-stage group (31.1 ± 10.6 vs. 23.4 ± 14.4 days and 105 ± 32 vs. 68 ± 18 min, respectively). Functional outcome improved in both groups from the pre- to post-operative period, but did not differ significantly between groups. CONCLUSION: The one-stage open surgical approach produced similar results to the two-stage approach in the treatment of extensive knee joint empyemas. However, by waiving the open joint treatment concept, duration of hospital stay and operation time could be significantly reduced. LEVEL OF EVIDENCE: III.

Medium-term results after total clavicle resection in cases of osteitis: a consecutive case series of five patients.

PURPOSE: Claviculectomy is a rare and poorly described event in the surgical therapy of diseases of the clavicle. We present a case series and functional results of patients who underwent total claviculectomy. METHODS: From 1995 to 2006 a total of 26 patients diagnosed with osteitis of the clavicle underwent surgery in our unit. Of these, five patients (all female) needed a total resection of the clavicle in order to ensure permanent healing from infection. The data collection was prospective. The data gathered preoperatively and at follow-up included clinical examinations, laboratory findings, radiographs and the Constant shoulder scores. The mean follow-up period was 7.5 months. RESULTS: The surgical concept described was able to eliminate infection in all cases studied within an average hospital stay of 13.4 days (8-18 days). Only one patient showed complications; suffering from chronic pain syndrome requiring surgical revision. After total resection of the clavicle four of five patients showed very good functional results. The average Constant score showed a significant increase from 82 before surgery to 95 at follow-up. CONCLUSIONS: The surgical technique described for total claviculectomy, along with the insertion of local antibiotic beads, was able to eliminate infection in every case. Good functional results and a low complication rates were observed. For good functional results and the permanent elimination of infection, adjacent joints have to be addressed, the periosteal tube should be preserved and early functional treatment is essential.

Surgical therapy of hip-joint empyema. Is the Girdlestone arthroplasty still up to date?

PURPOSE: Hip-joint empyema is a severe local infection that can cause general illness and, in the worst-case scenario, death by septic complications. For severe hip-joint infections, the Girdlestone arthroplasty has been an established treatment option for many decades. We describe functional midterm results after treatment of haematological and postoperative hip-joint infections. METHODS: From 2000 to 2010, 24 patients underwent surgical treatment for 27 hip-joint empyemas. The surgical procedures included radical debridement, implantation of local antibiotic beads and soft tissue management. Besides clinical, laboratory and imaging parameters, we analysed the Harris hip score (HHS). RESULTS: Twenty-three patients (26 hips) were followed up after a mean of 30 (3.1-126.8) months. The study group consists of 12 men and 11 women, with an average height of 1.71 m, weight of 84.7 kg and body mass index (BMI) of 28.6 kg/m(2). Hip-joint empyema was due to haematological septic spread in eight patients, surgery related in 12 hips and other causes in six cases. One patient died due to septic complications during the hospital stay. Intraoperative bacterial culture was positive in 50%, with Staphylococcus aureus as the most common organism (n = 11). Average hospital stay was 35 days. HHS significantly improved from 18.2 preoperatively to 47.8 at follow-up. Functional results were mainly poor, but pain relief increased significantly. The infection control rate was 96% with four (15%) complications. CONCLUSION: Resection arthroplasty by Girdlestone is able to control infection in most cases with an acceptable complication rate but poor functional results. In conclusion, the Girdlestone arthroplasty still is an essential surgical strategy for treating hip-joint empyema in cases in which functional outcome is of lesser priority.