Outcome and survival of septic arthritis treated with 0.05% chlorhexidine solution: Description of 10 cases

Abstract

Background

Established or ongoing septic arthritis requiring repeated joint flushing remains a treatment challenge with a poor survival outcome aggravated by the necessity of controlled antimicrobial usage.

Objective

To describe the outcomes and survival rates of patients with synovial sepsis treated by lavage with a 0.05% chlorhexidine solution.

Study design

Clinical retrospective observational study.

Methods

Patients with synovial sepsis underwent standing needle or arthroscopic lavage under general anaesthesia with a 0.05% chlorhexidine solution, followed by Lactate Ringer Solution (LRS). Complementary systemic and regional antibiotics were used. Short- (6 months) and long-term (>1 year) outcomes were assessed.

Results

Ten horses met the inclusion criteria. Affected joints included metacarpophalangeal joints (2), tarsocrural joint (1), radiocarpal and intercarpal joints (2), distal interphalangeal joints and navicular bursa (3), distal interphalangeal joints (2). Time from onset to referral ranged from 1 to 20 days, with a mean of 8.3 days. Eighty per cent of horses survived for more than 1 year. Four horses were retired to the field, three returned to a light level of work and one went back to full work.

Main limitations

Retrospective study of a limited group of horses initially treated by different clinicians before referral, as such, first-line treatment had differences between cases. Resolution was evaluated on based clinical signs rather than clinical pathology of synovial fluid due to clinical decisions or difficulty in obtaining samples.

Conclusion

With this series of challenging synovial sepsis cases treated by lavage with a chlorhexidine solution, we provide a treatment protocol, proof of clinical concept and report patients' short- and long-term clinical outcomes. Short- and long-term postoperative lameness should be expected despite the resolution of the septic arthritis. This treatment poses a novel option for challenging cases but should be regarded as a salvage procedure due to the possibility of long-term mild lameness.