Clinical Outcome of Arthroscopic Debridement for Septic Arthritis of Shoulder

Background: Septic arthritis of the shoulder is relatively rare; therefore, few reports have addressed the associated clinical outcomes. The purpose of the present study was to investigate the clinical outcomes of arthroscopic debridement in patients with septic arthritis of the shoulder. Methods: Fifteen patients with septic arthritis of the shoulder were treated at our institution between 2003 and 2011. Of these, we examined 10 patients (8 men and 2 women) who underwent arthroscopic debridement with the average follow-up period of 52.2 months (12?120 months). The average age at the onset was 65.6 years, ranging from36 to 90 years. The average time from the onset to the surgery was 12 days (4?25 days). The Gächter classification was used for intraoperative assessment and the Japanese Orthopaedic Association (JOA) score was for postoperative assessment. Results: All the patients had the underlying complications before surgery: hypertension, diabetes mellitus, liver dysfunction or rheumatoid arthritis. Intra-articular steroid injection was performed in 5 patients. The causative organism was Staphylococcus aureus in 4 patients, methicillin-resistant S. aureusin 4 patients, and unknown in the remaining 2 patients. Intraoparative evaluation using the Gächter classification system demonstrated 3 patients with stage I, 2 with stage II, 3 with stage III, and 2 with stage IV. In the 2 patients with stage IV, humeral head resection was performed within 1 year after the index surgery. Conclusions: The 2 patients with the Gächterstage IV who underwent bone resection after arthroscopic debridement had prolonged time from the onset to the surgery, compared with the other successful cases. These results therefore indicate the importance of arthroscopic surgery performed in early stage of the disease.