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©The Author(s) 2024.
World J Orthop. Aug 18, 2024; 15(8): 722-733
Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.722
Published online Aug 18, 2024. doi: 10.5312/wjo.v15.i8.722
Table 1 Distribution of gender, joint type, affected joint, imaging, and Echo results
Variables | Attributes | N | % |
Gender | Male | 26 | 50.0 |
Female | 26 | 50.0 | |
Joint type | Native | 33 | 63.5 |
Prosthetic | 19 | 36.5 | |
Affected joints | Knee | 42 | 80.8 |
Hip | 4 | 7.7 | |
Shoulder | 2 | 3.8 | |
Ankle | 2 | 3.8 | |
Elbow | 1 | 1.9 | |
Sterno-clavicular | 1 | 1.9 | |
Imaging | Joint effusion | 18 | 34.6 |
Joint effusion and osteomyelitis | 3 | 5.8 | |
Joint swelling | 1 | 1.9 | |
Loosening of prosthesis | 1 | 1.9 | |
Not done | 8 | 15.4 | |
Prosthetic joint fluency | 1 | 1.9 | |
Soft tissue swelling | 18 | 34.6 | |
Soft tissue swelling and osteomyelitis | 2 | 3.8 | |
Echo | Joint effusion | 2 | 3.8 |
Loosening of prosthesis | 1 | 1.9 | |
No vegetations | 20 | 38.5 | |
Not done | 22 | 42.3 | |
Soft tissue swelling | 4 | 7.7 | |
Vegetations | 3 | 5.8 |
Table 2 Organisms in native and prosthetic joints
Organism | N | % |
Native joints | ||
Bacteroides stercoris | 1 | 3.0 |
Coagulase-negative staphylococcus | 1 | 3.0 |
Enterobacter cloacae | 1 | 3.0 |
Enterococcus faecalis | 1 | 3.0 |
ESBL E. coli | 3 | 9.1 |
Lactobacillus | 1 | 3.0 |
Leuconostoc | 1 | 3.0 |
MRSA | 8 | 24.2 |
Polymicrobial | 1 | 3.0 |
Pseudomonas aeruginosa | 6 | 18.2 |
Salmonella | 1 | 3.0 |
Staphylococcus aureus MSSA | 5 | 15.2 |
Staphylococcus haemolyticus | 1 | 3.0 |
Streptococcus uberis | 1 | 3.0 |
Tuberculosis | 1 | 3.0 |
Prosthetic joints | ||
Brucella spp | 4 | 21.1 |
Coagulase-negative staphylococcus | 2 | 10.5 |
E. coli | 2 | 10.5 |
Enterococcus faecalis | 1 | 5.3 |
ESBL klebsiella pneumoniae | 1 | 5.3 |
MRSA | 1 | 5.3 |
Pseudomonas aeruginosa | 2 | 10.5 |
Ralstonia | 1 | 5.3 |
Staphylococcus aureus MSSA | 2 | 10.5 |
Staphylococcus epidermidis | 1 | 5.3 |
Staphylococcus lugdunensis | 1 | 5.3 |
Tuberculosis | 1 | 5.3 |
Table 3 Comparison of clinical features in native vs prosthetic joints
Clinical feature | Presence | Native | Prosthetic | Odds ratio | P value | ||
N | % | N | % | ||||
Joint pain | Yes | 31 | 93.9 | 16 | 45.5 | 0.344 | 0.252 |
No | 2 | 6.1 | 3 | 15.8 | |||
Fever | Yes | 15 | 45.5 | 9 | 47.4 | 1.080 | 0.894 |
No | 18 | 54.5 | 10 | 52.6 | |||
Joint swelling | Yes | 33 | 100 | 17 | 98.5 | 2.941 | 0.057 |
No | 0 | 0 | 2 | 10.5 | |||
Joint limitation | Yes | 30 | 90.9 | 17 | 89.5 | 0.856 | 0.866 |
No | 3 | 9.1 | 2 | 10.5 |
Table 4 Risk factors/comorbidities
Risk factors/comorbidities present | All cases | Native | Prosthetic | Odds ratio | P value | |||
N | % | N | % | N | % | |||
Complicated by osteomyelitis | 11 | 21.2 | 9 | 27.3 | 2 | 10.5 | 0.314 | 0.154 |
Associated with necrotizing fasciitis | 7 | 13.5 | 2 | 6.1 | 5 | 26.3 | 0.536 | 0.039 |
DM | 36 | 69.2 | 22 | 66.7 | 14 | 73.7 | 1.400 | 0.598 |
HTN | 29 | 55.8 | 19 | 57.6 | 10 | 52.6 | 0.819 | 0.730 |
Renal impairment | 23 | 44.2 | 20 | 60.6 | 3 | 15.8 | 0.122 | 0.002 |
Hemodialysis | 15 | 28.8 | 14 | 42.4 | 1 | 5.3 | 0.075 | 0.004 |
Heart disease | 13 | 25.0 | 12 | 36.4 | 1 | 5.3 | 0.097 | 0.013 |
CVD | 5 | 9.6 | 3 | 9.1 | 2 | 10.5 | 1.176 | 0.866 |
CLD | 6 | 11.5 | 6 | 18.2 | 0 | 0 | 0.587 | 0.048 |
Malignancy | 4 | 7.7 | 2 | 6.1 | 2 | 10.5 | 1.824 | 0.561 |
Hematological malignancy | 1 | 1.9 | 1 | 3.0 | 0 | 0 | 0.627 | 0.444 |
Solid organ malignancy | 4 | 7.7 | 2 | 6.1 | 2 | 10.5 | 0.339 | 0.561 |
Surgery within 90 days before Dx | 5 | 9.6 | 2 | 6.1 | 2 | 10.5 | 2.906 | 0.252 |
Osteoarthritis | 12 | 23.1 | 4 | 12.1 | 3 | 15.8 | 5.273 | 0.013 |
Rheumatoid arthritis | 2 | 3.8 | 0 | 0.0 | 2 | 10.5 | 0.340 | 0.057 |
Psoriasis | 1 | 1.9 | 1 | 3.0 | 0 | 0 | 0.627 | 0.444 |
Sickler | 1 | 1.9 | 1 | 3.0 | 0 | 0 | 0.627 | 0.444 |
Other rheumatological disease | 1 | 1.9 | 1 | 3.0 | 0 | 0 | 0.627 | 0.444 |
Past septic arthritis | 1 | 1.9 | 0 | 0 | 1 | 3.0 | 0.353 | 0.183 |
Hx of trauma | 9 | 17.3 | 4 | 12.1 | 5 | 26.3 | 2.589 | 0.181 |
Table 5 Distribution of numerical variables
Variables | Mean | Median | SD |
BMI | 28.63 | 27.00 | 6.61 |
Age | 59.31 | 64.00 | 17.53 |
CRP | 7535.66 | 148.50 | 35267.86 |
Cell count from aspiration | 102998.04 | 49375.00 | 139227.01 |
RBC | 90367.48 | 10583.00 | 366693.04 |
Neutrophil | 76.21 | 84.00 | 27.52 |
Lymphocyte | 4.96 | 4.00 | 3.59 |
Monocyte | 10.14 | 10.00 | 8.63 |
Charlson index | 2.79 | 2.00 | 2.28 |
Duration of antimicrobials in days | 69.86 | 42.00 | 100.61 |
Table 6 Tuberculosis acid-fast bacilli, tuberculosis polymerase chain reaction, tuberculosis culture, histopathology
Test | Status | N | % |
TB AFB | Negative | 18 | 34.6 |
Not sent | 33 | 63.5 | |
Positive | 1 | 1.9 | |
TB PCR | Positive | 2 | 3.8 |
Negative | 12 | 23.1 | |
Not sent | 38 | 73.1 | |
TB culture | Negative | 15 | 28.8 |
Not sent | 35 | 67.3 | |
Positive | 2 | 3.8 | |
Histopathology | Exudate and granulation tissue | 1 | 1.9 |
Features of septic joint | 2 | 3.8 | |
Features of synovitis | 1 | 1.9 | |
Inflamed granulation tissue | 2 | 3.8 | |
Inflammatory changes | 2 | 3.8 | |
Noncaseating granuloma | 1 | 1.9 | |
Not sent | 43 | 82.7 |
Table 7 Antibiotics used to treat
Specifics | N | % | |
Antibiotics | Vancomycin | 14 | 26.9 |
Ceftriaxone | 6 | 11.5 | |
Meropenem | 5 | 9.6 | |
Cloxacillin | 4 | 7.7 | |
Ceftazidime | 3 | 5.8 | |
Antituberculous drugs | 2 | 3.8 | |
Cefazolin | 2 | 3.8 | |
Ceftriaxone + rifampin | 2 | 3.8 | |
Ciprofloxacin | 2 | 3.8 | |
Imipenem | 2 | 3.8 | |
Piperacillin tazobactam | 2 | 3.8 | |
Streptomycin + rifampin + doxycycline | 2 | 3.8 | |
Ampicillin | 1 | 1.9 | |
Cefepime | 1 | 1.9 | |
Gentamicin + rifampin + doxycycline | 1 | 1.9 | |
Piperacillin tazobactam, vancomycin, clindamycin | 1 | 1.9 | |
Streptomycin + rifampin | 1 | 1.9 | |
Teicoplanin | 1 | 1.9 |
Table 8 Antibiotic prior aspiration, treatment, surgery
Variables | Attributes | N | % |
Antibiotics prior aspiration | Yes | 30 | 57.7 |
No | 22 | 42.3 | |
Appropriateness of treatment | Appropriate | 45 | 86.5 |
Inappropriate | 7 | 13.5 | |
Surgical treatment | Arthrotomy | 17 | 32.7 |
Joint preservation | 7 | 13.5 | |
Arthroscopic irrigation | 6 | 11.5 | |
Two-stage exchange | 6 | 11.5 | |
Debridement, antibiotics, and implant retention | 4 | 7.7 | |
Above knee amputation | 1 | 1.9 | |
None | 11 | 21.2 |
Table 9 Correlation between numerical variables
BMI | AGE | CRP | Cell count | RBC | Neutrophil | Lymphocyte | Monocyte | Creatinine | Charlson | ||
AGE | r value | 0.372b | |||||||||
P value | 0.007 | ||||||||||
CRP | r value | 0.025 | 0.048 | ||||||||
P value | 0.861 | 0.739 | |||||||||
Cell count | r value | -0.049 | -0.180 | 0.213 | |||||||
P value | 0.731 | 0.201 | 0.137 | ||||||||
RBC | r value | -0.042 | 0.017 | -0.331a | 0.279a | ||||||
P value | 0.769 | 0.906 | 0.019 | 0.045 | |||||||
Neutrophil | r value | -0.310 | -0.192 | 0.097 | 0.082 | 0.177 | |||||
P value | 0.140 | 0.368 | 0.659 | 0.702 | 0.407 | ||||||
Lymphocyte | r value | 0.124 | 0.265 | -0.148 | -0.349 | -0.050 | -0.406 | ||||
P value | 0.565 | 0.211 | 0.500 | 0.094 | 0.818 | 0.055 | |||||
Monocyte | r value | 0.379 | 0.430 | -0.543a | -0.311 | 0.134 | -0.816b | 0.191 | |||
P value | 0.091 | 0.052 | 0.013 | 0.170 | 0.564 | 0.000 | 0.421 | ||||
Creatinine | r value | -0.100 | 0.171 | 0.258 | 0.240 | 0.074 | 0.186 | -0.357 | -0.170 | ||
P value | 0.514 | 0.260 | 0.095 | 0.113 | 0.631 | 0.419 | 0.122 | 0.461 | |||
Charlson | r value | -0.184 | -0.041 | -0.070 | 0.331a | 0.272 | 0.268 | -0.391 | -0.112 | 0.762b | |
P value | 0.192 | 0.771 | 0.630 | 0.016 | 0.051 | 0.205 | 0.059 | 0.629 | 0.000 | ||
Duration of antimicrobials in days | r value | 0.109 | 0.253 | 0.058 | -0.470b | -0.308a | 0.121 | -0.003 | 0.298 | -0.325a | -0.458b |
P value | 0.480 | 0.098 | 0.715 | 0.001 | 0.042 | 0.612 | 0.990 | 0.202 | 0.031 | 0.002 |
Table 10 Association between variables of interest
Association between | Odds ratio | P value |
Joint type and mortality | 0.587 | 0.048 |
Mortality and appropriateness of treatment | 0.848 | 0.304 |
Platelet count and mortality | - | 0.273 |
WBC count and mortality | - | 0.382 |
Table 11 Relationship between Charlson comorbidity index and mortality
Charlson comorbidity index | |
Alive, mean ± SD | 2.39 ± 2.02 |
Dead, mean ± SD | 5.83 ± 5.50 |
P value | 0.001 |
- Citation: Kaki R. Native and prosthetic septic arthritis in a university hospital in Saudi Arabia: A retrospective study. World J Orthop 2024; 15(8): 722-733
- URL: https://www.wjgnet.com/2218-5836/full/v15/i8/722.htm
- DOI: https://dx.doi.org/10.5312/wjo.v15.i8.722