[Septic Arthritis of the Wrist Joint: Cohort of Patients Treated between 2003 and 2023, Guidelines for the Diagnosis and Treatment].

Purpose of the study: The study aimed to evaluate the timeliness and effectiveness of treatment of all patients who underwent surgery for septic arthritis of the wrist at our department between 2003 and 2023.

Material and methods: The retrospective study included 38 patients (26 men and 12 women). The mean age of the patients was 68 years. All patients underwent surgery for culture-positive arthritis of the native wrist. Patients with periprosthetic and extraarticular infections were excluded from the study. Once the diagnosis was established based on the clinical examination and laboratory analysis of blood and synovial fluid, antibiotic treatment was administered and revision surgery was performed. Arthroscopic procedure was used in the unaffected wrist, whereas open surgery was opted for in case of any degenerative changes of the wrist joint and extra-articular spread of infection. A total of 50 surgeries were performed, of which 6 arthroscopies, 32 open arthrotomies, 2 open surgeries with proximal row carpectomy, 6 open surgeries with simultaneous resection arthrodesis, 2 revision surgeries with arthrodesis via internal fixation for prolonged healing, 2 revision surgeries for another postoperative complication.

Results: In our study cohort of patients with septic arthritis, the arthritis of the wrist represented 7%. The most common pathogen was Staphylococcus aureus (60.5%). In 35 patients (92%) at least one risk factor for septic arthritis was present. In all patients, signs of local inflammation were present. 17 patients showed signs of system-wide inflammation and in 32 patients laboratory markers of inflammation were reported. In 6 cases both sides were affected. In our cohort the lethality reached 8%. These were patients with severe immunodeficiency and multiple loci of infection. Full recovery was achieved in 35 patients (92%), i.e. in all surviving patients, in whom the wrist joint was stable upon treatment completion and the self-care was not limited.

Discussion: The prevailing part of the patients (92.10%) with septic arthritis of the wrist showed risk factors for the development of septic arthritis, i. e. poor overall health condition of the patient, immunosuppression, organ failure, diabetes, age over 65 years, rheumatoid arthritis, surgery or trauma, drug or alcohol abuse. In case of bacteremia or sepsis, the risk factors include also chronic degenerative or inflammatory changes in the wrist region, with synovitis constituting a predisposition for hematogenous spread of septic arthritis of the wrist. Our cohort clearly confirms that the system-wide signs and laboratory markers of inflammation are nonspecific markers which cannot conclusively confirm the diagnosis of septic arthritis of the wrist, but the development of their values over time demonstrates the effect of treatment used. The presence of degenerative changes of the wrist joint influences the choice of surgical procedure.

Conclusions: Septic arthritis of the wrist ranks among the less common types of arthritis. Early diagnosis should promptly be followed by adequate surgical treatment. Correct early management increases the likelihood of full recovery, even in high-risk patients.