Bacterial arthritis of native joints can be successfully managed with needle arthroscopy

Purpose To assess the feasibility of needle arthroscopy for management of suspected bacterial arthritis in native joints. Methods During a pilot period, patients presenting with symptoms suggestive of native joint bacterial arthritis were eligible for initial management with needle arthroscopy. Procedures were performed in the operating theatre or at the patient bedside in the emergency department or inpatient ward. As our primary outcome measure, it was assessed whether needle arthroscopic lavage resulted in a clear joint. In addition, the need for conversion to standard arthroscopy or arthrotomy, the need for conversion from local to general anaesthesia, complications and the need for additional surgical intervention at follow-up during admission were recorded. Results Eleven joints in 10 patients (four males, age range 35 – 77) were managed with needle arthroscopy. Needle arthroscopic lavage resulted in a clear joint in all cases. Conversion to standard arthroscopy or arthrotomy was not needed. Seven procedures were performed at the patient bedside using local anaesthesia. These procedures were well tolerated and conversion to general or spinal anaesthesia was not required. There were no procedure complications. One patient received multiple needle arthroscopic lavages. No further surgical interventions beside the initial needle arthroscopic lavage were required for successful management in other cases. Conclusions Needle arthroscopy can be a feasible tool in the initial management of complaints suggestive for native joint bacterial arthritis, providing an effective, quick and well-tolerable intervention in the operating theatre or at the patient bedside, with the potential to relief health systems from need for scarce operating theatre time.

Intra-Articular Administration of Autologous Purified Adipose Tissue Associated with Arthroscopy Ameliorates Knee Osteoarthritis Symptoms

The aim of this study was to evaluate the safety and efficacy of the intra-articular administration of autologous purified adipose tissue to treat knee osteoarthritis (OA) following arthroscopy. Thirty patients with radiological evidence of knee OA were recruited. A small liposuction and arthroscopic lavage and debridement were performed in the same surgical time. The harvested fat was processed intraoperatively with Lipocell (Tiss’You, RSM) to purify the adipose tissue injected into the knee. Clinical evaluations were performed with VAS, Womac, and Lequesne questionnaires before treatment and after 1, 3, 6, and 12 months of follow-up. Pain, measured with VAS, significantly decreased, showing a reduction of 53% after 1 month and 83% after a year. Functional recovery, measured with Womac, showed an improvement of 47% after 1 month post-treatment and 84% after 1 year. No adverse effects have been observed. The intra-articular administration of purified adipose tissue associated with arthroscopic lavage and debridement is a safe and significantly effective strategy in improving the symptoms of knee osteoarthritis in up to 1 year of follow-up.

A Rare Case of Joint Infection due to Raoultella planticola

Raoultella planticola, a gram-negative bacterium, first emerged in late 1900s as Klebsiella planticola. It was later classified as Raoultella genus in 2001. This nonmotile rod is usually found in soil and aquatic environment. There are two known species of Raoultella: R. planticola and R. ornithinolytica. They are responsible for numerous yet rare infections including cystitis, pneumonia, and bacteremia. To date, only one case of joint or bone infection due to R. planticola has been reported. The infection is eradicated after arthroscopic lavage and antibiotic therapy with fluoroquinolones. We present the first case of septic arthritis due to R. planticola involving a native knee joint following synovectomy during arthroscopy.

Functional Outcome for Arthroscopic Treatment of Septic Arthritis of the Wrist

Background Septic arthritis is a potentially joint-destructing condition if not treated properly. Septic wrist accounts for ∼5% of all septic arthritis. Arthroscopic lavage is a well-documented treatment for septic arthritis of the knee, hip, or shoulder only. Previous studies on septic wrist were limited to case reports or retrospective studies focusing on open treatment, and functional outcome was seldom documented. Our study aims to evaluate the effectiveness of arthroscopic treatment and to investigate the functional outcome. Materials and Methods Patients were retrospectively reviewed over a period of 10 years. Parameters including age, gender, history of prior injury, duration of symptoms, joint aspirates and intraoperative tissue culture, radiological and arthroscopic findings, antibiotics used, number of operations, and hospital stay were reviewed. Functional outcomes were evaluated with QuickDASH (disabilities of the arm, shoulder, and hand) score. Results From 2007 to 2016, 14 patients (15 septic wrists) underwent arthroscopic surgery. One patient had bilateral involvement. The average age was 63.9 years and the average duration of symptoms was 6.08 days. Average follow-up time was 10 months. All except two patients (85.7%) responded to single arthroscopic treatment. Two required subsequent operations for concomitant tenosynovitis. There were no major complications. The most common isolated organism was Staphylococcus aureus. Only one case had severe joint erosion during follow-up. The average QuickDASH score was 19.7. Duration of symptoms 5 days or more before admission was associated with higher QuickDASH score (p = 0.04). Conclusion Early arthroscopic treatment should be considered for all patients admitted for septic arthritis of the wrist if not contraindicated. Level of Evidence This is a Level III, retrospective review.

Indications and effectiveness of arthroscopic lavage and debridement in osteoarthritis knee

Background: Degenerative joint disease will afflict most of the people if they live long enough. The majority of patients with osteoarthritis present to orthopaedic surgeons seeking relief of pain and associated restoration of function. Various intraarticular and periarticular structures may be the cause of pain. Improvement in osteoarthritis by arthroscopic lavage and debridement is seen due to various mechanisms.Methods: In a prospective study from July 2016 to December 2018, 35 patients with primary osteoarthritis knee were assessed for effectiveness of arthroscopic lavage and debridement in relieving symptoms of osteoarthritis of knee and to determine the indications of arthroscopy in osteoarthritis of knee. Assessment was done using variables as age of the patient, body mass index, varus deformity, radiographic grading and arthroscopic grading.Results: A declining trend was seen on follow up over time; 91.4% excellent to good results seen at one month follow up, 76.1% at six months, 49.93% at twelve months, 37.5%, at eighteen months, 23.07% at twenty-four months and 28.5% at thirty months. Results at six month follow up when compared, were better for age less than 50 years (88.8% Vs 73.1% in >50 years age), normal weight patients with BMI 18.5 to 25(94.5% Vs 58.5% in overweight), varus angulation <100(93.1% Vs 0% in >100), radiological grade I and II (95-100% Vs 45-50% in grade III and IV) and arthroscopic grade I and II (94-100% Vs 0-77% in grade III and IV).Conclusions: Arthroscopic lavage and debridement is an effective method of treatment for osteoarthritis knee in patients with grade I and grade II osteoarthritis having symptoms of pain and locking due to loose bodies or degenerative meniscal tears.