Injection drug use is associated with repeat irrigation and debridement in native joint septic arthritis.

Abstract

Septic arthritis is an orthopaedic emergency that requires prompt irrigation and debridement (I&D). Some patients require a repeat I&D, which poses excessive burden on the patient and provider. The goal of this study was to identify possible risk factors for repeat I&D in the setting of native septic arthritis. Consecutive patients with a primary diagnosis of native joint septic arthritis from June 2014-November 2018 at two level-one trauma centers were retrospectively identified via billing codes. Patients were included if they had a clinical presentation consistent with native septic arthritis. Independent-sample T-tests, Fisher's Exact Tests, and multivariable logistic regression were performed to determine what risk factors for repeat I&D were statistically significant. Two-hundred and twenty-one patients were identified, and 192 were included in the final analysis (36 % female, 64 % male, mean age 53 years). 231 joints were included in the analysis (knee, n = 115; hip, n = 53; shoulder, n = 37; other, n = 16). 29 % of septic joints were associated with injection drug use (IDU-SA). 30 % of IDU-SA cases required a repeat I&D compared to 17 % for non IDU-SA cases (p = 0.03). IDU-SA patients were associated with more total I&Ds compared to patients without IDU-SA (1.70 vs. 1.32; p = 0.048). This association remained significant when controlling for smoking history, diabetes, human immunodeficiency virus, immunocompromised status, and steroid use. IDU-SA was associated with repeat I&D. Physicians working with IDU-SA patients should alter postoperative surveillance standards and consider adopting a multimodal team approach to improve septic arthritis management.