Treatment of acute shoulder infection: can osseous lesion be a rudder in guideline for determining the method of debridement?

초록

Background: There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. Methods: We retrospectively reviewed 57 patients who underwent arthroscopic or open debridement for acute shoulder infection between 2001 and 2015. Arthroscopic debridement was performed in 27 patients, and open debridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2. n = 21, erosions seen in MM but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). Results: The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/ 10) and 15.4% (2113) in group 1; 75% (9/12) and 11.1% (1/9) in group 2: and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell. erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P < .05). Conclusions: When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic debridement was above 75%. Therefore, if preoperative MRI showed emsions, open debridement is more likely to be appropriate than arthroscopic debridement. (C) 2019 Journal of Shoulder and Elbow Surgery Board of Trustees. All rights reserved.

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