Advertisement

Surgical Treatment of Septic Shoulders: A Comparison Between Arthrotomy and Arthroscopy

      Purpose

      To compare the efficacy, as measured through the rate of reoperation, and rates of other 30-day perioperative complications between arthrotomy and arthroscopy for the treatment of septic native shoulders in a national patient population.

      Methods

      Patients who were diagnosed with septic arthritis in a native shoulder and underwent irrigation and debridement through arthrotomy or arthroscopy were identified in the 2005-2016 National Surgical Quality Improvement Program database. Patient preoperative characteristics were characterized. Rate of reoperation, a proxy used to measure treatment efficacy, and other perioperative complications were compared between the 2 procedures.

      Results

      In total, 100 patients undergoing shoulder arthrotomy and 155 patients undergoing shoulder arthroscopy for septic shoulder were identified. On univariate analysis, there were no statistically significant differences in patient preoperative characteristics, operative time (60 vs. 48 minutes, P = .290), length of stay (7.5 vs. 6.6 days, P = .267), or time to reoperation (8.9 vs. 7.2 days, P = .594) between the 2 surgical groups. On multivariate analysis controlling for patient characteristics, there were no statistically significant differences in risk of reoperation (relative risk [RR] = 1.914, 99% confidence interval [CI] = 0.730-5.016, P = .083), any adverse events (RR = 1.254, 99% CI = 0.860-1.831, P = .122), minor adverse events (RR = 1.304, 99% CI = 0.558-3.047, P = .421), serious adverse events (RR = 1.306, 99% CI = 0.842-2.025, P = .118), or readmission (RR = 0.999, 99% CI = 0.441-2.261, P = .998) comparing arthrotomy with arthroscopy.

      Conclusions

      By demonstrating similar rates of reoperation, other postoperative complications, and 30-day readmissions, the current study suggests that arthrotomy and arthroscopic surgery have similar efficacy in treating septic shoulders. However, owing to the small sample size, there is still the possibility of a type II error.

      Level of Evidence

      Level III, therapeutic retrospective comparative study.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Arthroscopy
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Jiang J.J.
        • Piponov H.I.
        • Mass D.P.
        • Angeles J.G.
        • Shi L.L.
        Septic arthritis of the shoulder: A comparison of treatment methods.
        J Am Acad Orthop Surg. 2017; 25: e175-e184
        • Bohler C.
        • Pock A.
        • Waldstein W.
        • et al.
        Surgical treatment of shoulder infections: A comparison between arthroscopy and arthrotomy.
        J Shoulder Elbow Surg. 2017; 26: 1915-1921
        • Memon M.
        • Kay J.
        • Ginsberg L.
        • et al.
        Arthroscopic management of septic arthritis of the native shoulder: A systematic review.
        Arthroscopy. 2018; 34: 625-646.e621
        • Abdel M.P.
        • Perry K.I.
        • Morrey M.E.
        • Steinmann S.P.
        • Sperling J.W.
        • Cass J.R.
        Arthroscopic management of native shoulder septic arthritis.
        J Shoulder Elbow Surg. 2013; 22: 418-421
        • Garofalo R.
        • Flanagin B.
        • Cesari E.
        • Vinci E.
        • Conti M.
        • Castagna A.
        Destructive septic arthritis of shoulder in adults.
        Musculoskelet Surg. 2014; 98: 35-39
        • McLynn R.P.
        • Geddes B.J.
        • Cui J.J.
        • et al.
        Inaccuracies in ICD coding for obesity would be expected to bias administrative database spine studies toward overestimating the impact of obesity on perioperative adverse outcomes.
        Spine (Phila Pa 1976). 2018; 43: 526-532
        • George J.
        • Newman J.M.
        • Ramanathan D.
        • Klika A.K.
        • Higuera C.A.
        • Barsoum W.K.
        Administrative databases can yield false conclusions—An example of obesity in total joint arthroplasty.
        J Arthroplasty. 2017; 32: S86-S90
        • Bovonratwet P.
        • Bohl D.D.
        • Russo G.S.
        • et al.
        How common—and how serious—is Clostridium difficile colitis after geriatric hip fracture? Findings from the NSQIP dataset.
        Clin Orthop Relat Res. 2018; 476: 453-462
        • Peres L.R.
        • Marchitto R.O.
        • Pereira G.S.
        • Yoshino F.S.
        • de Castro Fernandes M.
        • Matsumoto M.H.
        Arthrotomy versus arthroscopy in the treatment of septic arthritis of the knee in adults: A randomized clinical trial.
        Knee Surg Sports Traumatol Arthrosc. 2016; 24: 3155-3162
        • Jaffe D.
        • Costales T.
        • Greenwell P.
        • Christian M.
        • Henn 3rd, R.F.
        Methicillin-resistant Staphylococcus aureus infection is a risk factor for unplanned return to the operating room in the surgical treatment of a septic knee.
        J Knee Surg. 2017; 30: 872-878
        • Bovonratwet P.
        • Webb M.L.
        • Ondeck N.T.
        • et al.
        Discrepancies in the definition of “outpatient” surgeries and their effect on study outcomes related to ACDF and lumbar discectomy procedures: A retrospective analysis of 45,204 cases.
        Clin Spine Surg. 2018; 31: E152-E159
        • Bovonratwet P.
        • Ottesen T.D.
        • Gala R.J.
        • et al.
        Outpatient elective posterior lumbar fusions appear to be safely considered for appropriately selected patients.
        Spine J. 2018; 18: 1188-1196
        • Ondeck N.T.
        • Bohl D.D.
        • Bovonratwet P.
        • et al.
        Discriminative ability of commonly used indices to predict adverse outcomes after poster lumbar fusion: A comparison of demographics, ASA, the modified Charlson Comorbidity Index, and the modified Frailty Index.
        Spine J. 2018; 18: 44-52
        • Bovonratwet P.
        • Nelson S.J.
        • Bellamkonda K.
        • et al.
        Similar 30-day complications for septic knee arthritis treated with arthrotomy or arthroscopy: An American College of Surgeons National Surgical Quality Improvement Program analysis.
        Arthroscopy. 2018; 34: 213-219
        • Ranstam J.
        Multiple P-values and Bonferroni correction.
        Osteoarthritis Cartilage. 2016; 24: 763-764
        • Townshend D.
        • Di Silvestro M.
        • Krause F.
        • et al.
        Arthroscopic versus open ankle arthrodesis: A multicenter comparative case series.
        J Bone Joint Surg Am. 2013; 95: 98-102
        • Bovonratwet P.
        • Malpani R.
        • Ottesen T.D.
        • et al.
        Aseptic revision total hip arthroplasty in the elderly: Quantifying the risks for patients over 80 years old.
        Bone Joint J. 2018; 100-B: 143-151
      1. ACS-NSQIP. User Guide for the 2015 ACS NSQIP Participant Use Data File. American College of Surgeons. https://www.facs.org/~/media/files/quality%20programs/nsqip/nsqip_puf_user_guide_2015.ashx.

        • Bovonratwet P.
        • Webb M.L.
        • Ondeck N.T.
        • et al.
        Definitional differences of ‘outpatient’ versus ‘inpatient’ THA and TKA can affect study outcomes.
        Clin Orthop Relat Res. 2017; 475: 2917-2925