Purpose
To investigate arthroscopic management of native shoulder joint septic arthritis—specifically,
indications, patient outcomes, and complications.
Methods
PubMed, MEDLINE, and Embase were used to search the literature, and data abstraction
was performed independently and in duplicate. The Preferred Reporting Items for Systematic
Reviews and Meta-analyses (PRISMA) checklist guided reporting and data abstraction.
The quality of all included studies was assessed with the Methodological Index for
Non-randomized Studies (MINORS) criteria. The results are presented in a narrative
summary fashion using descriptive statistics including means, proportions, ranges,
κ values, and intraclass correlation coefficient values.
Results
Overall, 27 studies (19 case reports and 8 case series) were identified, including
115 patients (121 shoulders). The mean follow-up period was 29.1 months (range, 1-199 months).
The indications for shoulder arthroscopy owing to infection included pain; limited
range of motion; swelling, erythema, and tenderness; fever; elevated leukocyte count,
erythrocyte sedimentation rate, and/or C-reactive protein level; synovial aspirate
findings; and/or imaging findings. Overall, 46 patients (40%) achieved infection eradication
and functional improvement after a single arthroscopic procedure. However, 43 patients
(37%) had ongoing symptoms or complications, including 32 (30%) who required revision
arthroscopic procedures, 7 (6%) who underwent open arthrotomy for septic arthritis
management, 2 (2%) in whom avascular necrosis of the humeral head developed, 1 (1%)
in whom adhesive capsulitis developed, and 1 (1%) in whom an irregular profile of
the humeral epiphysis developed on plain radiographs.
Conclusions
Arthroscopic management of native shoulder septic arthritis can yield alleviation
of pain and a return to full range of motion, daily activities, and sports. However,
there is a high reoperation rate, which may correlate with poor patient prognostic
factors. This systematic review did not show the superiority of either arthroscopic
surgery or open arthrotomy for the management of shoulder septic arthritis.
Level of Evidence
Level IV, systematic review of Level IV studies.
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Article Info
Publication History
Published online: October 30, 2017
Accepted:
July 23,
2017
Received:
March 28,
2017
Footnotes
The authors report that they have no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2017 by the Arthroscopy Association of North America
