Septic Arthritis of the Shoulder: A Comparison of Treatment Methods.

INTRODUCTION: In-hospital outcomes were compared among patients with shoulder septic arthritis treated with arthrocentesis, open irrigation and débridement, or arthroscopic irrigation and débridement.

METHODS: The Nationwide Inpatient Sample database was queried for all cases of native shoulder septic arthritis between 2002 and 2011. Patient demographics, comorbidities, and hospitalization complications were compared for the shoulder arthrocentesis (nonsurgical) and open or arthroscopic irrigation and débridement (surgical) groups.

RESULTS: Data for 7,145 patients were analyzed. Medical comorbidities and complications were more common in the nonsurgical group than in the open surgical group (septicemia, 36.7% versus 23.6%, P < 0.001; death, 6.5% versus 2.5%, P < 0.001; pneumonia, 11.3% versus 6.2%, P < 0.001; septic shock, 4% versus 2.2%, P < 0.001; and urinary tract infection, 15.5% versus 10.2%, P < 0.001). The mean length of stay was longer in the nonsurgical group compared with the open surgical group (11.5 days versus 10.5 days, respectively; P = 0.002) and the percentage of patients discharged to home was lower (55.1% versus 64.0%, respectively; P < 0.001). Compared with the open surgical group, the arthroscopic surgical group had higher incidences of perioperative septicemia and urinary tract infection and similar average length of stay, hospital charges, and blood transfusion rates, but a lower incidence of osteomyelitis (P < 0.001). In a subgroup of patients with septicemia, Staphylococcus aureus was the most frequently cultured causative organism.

DISCUSSION: Septic arthritis in the shoulder is challenging to manage, and patients often have medical comorbidities and complications. In this study, the nonsurgically treated patients had substantially more preexisting comorbidities and in-hospital complications than the surgically treated patients had, which likely contributed to the longer average length of stay and lower discharge percentage in the nonsurgical group.

CONCLUSION: Patients with septic arthritis of the shoulder frequently experience substantial systemic complications regardless of the treatment method. Septicemia was a common complication among all treatment groups, with cultures most frequently indicating Staphylococcus aureus as the causative organism.

LEVEL OF EVIDENCE: Therapeutic level III.