Pyarthrosis of the small joints of the hand resulting in arthrodesis or amputation

Abstract

Purpose: A septic joint is a cartilage-threatening emergency requiring prompt treatment. The purpose of this study was to examine outcomes of septic arthritis of the metacarpophalangeal and interphalangeal joints.

Methods: We performed a retrospective review of patients diagnosed with joint infection between 1976 and 2008. The end point included the number of arthrodeses and amputations performed.

Results: Septic joints were identified in 110 patients. All patients had incision and irrigation and debridement (I and D) of the joint. The infection was successfully treated in 83 of 110 patients. The majority of septic joints (73 of 83 patients) treated successfully with I and D had only a penetrating joint injury. Forty-eight of these patients required more than one I and D to eradicate the infection. The remaining 27 of 110 patients required either arthrodesis (13 patients) or amputation (14 patients) despite I and D. Among the 13 patients requiring arthrodesis, postoperative infection (7 patients) accounted for the majority of septic joints. Of the 14 patients requiring amputation, penetrating joint injury accounted for the majority of septic joints. Overall, those patients requiring more than 3 I and D procedures were at higher risk of arthrodesis or amputation. Increasing comorbidities correlated with worsening outcomes.

Conclusions: Pyarthrosis can often be treated successfully with 1 or more I and D procedures. Despite multiple I and D procedures, 27 patients required either arthrodesis or amputation. The time to diagnosis and treatment, the number of I and D procedures, patient comorbidities, and postoperative infection following non-joint surgery are major factors influencing outcome.