Date of Award

January 2017

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Shaili Gupta

Abstract

Objective: Septic arthritis is a medical emergency with significant associated morbidity and mortality that requires joint drainage in addition to antibiotic therapy. Closed-needle aspiration and surgery (via arthrotomy or arthroscopy) are the standard approaches to joint drainage, though little data exists regarding treatment outcomes with each approach. We compared long-term outcomes for adult patients with septic arthritis of a native joint based on whether they received a ‘medical’ or ‘surgical’ approach to joint drainage.

Methods: We retrospectively reviewed all chart records for patients diagnosed with septic arthritis at the West Haven VA Medical Center between January 2006 and December 2015. Treatment outcomes were recorded at one year post-diagnosis.

Results: Sixty-two patients were diagnosed with native joint septic arthritis during the study period, 19 who were managed medically and 43 surgically. There was no significant difference in demographic variables, risk factors, clinical presentation, laboratory parameters, or duration of antibiotic therapy between the two groups. 81% of medically-managed patients and 82% of surgically-managed patients achieved a full recovery within 12 months. Overall mortality was 3.2%, and both patients who died were managed surgically. There were no significant predictors of poor treatment outcome aside from Black race.

Conclusion: Our findings suggest that medical management of septic arthritis with closed-needle aspiration is non-inferior to surgical management in terms of both morbidity and mortality. Given the small sample size, a prospective randomized control trial is needed to guide definitive recommendations on the best form of joint drainage

Comments

This is an Open Access Thesis.

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