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Iatrogenic Septic Arthritis Following Radiologically Guided Joint Injection

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Iatrogenic Septic Arthritis Following Radiologically Guided Joint Injection

Septic arthritis (SA) causes undoubted morbidity and ultimately mortality. Consequently, this carries grave significance to patients and profound medico-legal implications to health professionals when cases are iatrogenic. Following local cases of SA from radiologically-guided joint injections, we aimed to compare performance with the available standards and target improved services.

Three cases were identified from the departmental logbook. For complications stemming from SA, each patient required ITU admission, multiple surgical interventions and prolonged hospital admissions. Long-term sequelae included renal failure, cardiac arrhythmias, thromboembolic disease, distant infections and chronic pain.

Limited literature exists concerning the risk of SA following joint injection. Earlier papers (1969-1991) quote between 1:20,000-500,0001-3 and the Australian health service 1:20,000-75,0004. However, the most robust source - an Icelandic study (2008) determines a risk of 1:2,700; with 17.9% of SA cases originating from arthrocentesis5.

Over the past 6 years, 5,363 joint injections were performed in the Radiology Department of our 410-bed District General Hospital under both ultrasound and fluoroscopic guidance. Using a 6-year cut-off, this generates a 1:1788 risk of SA – considerably higher than the literature.

Questions were raised at multi-disciplinary meetings over the suitability of the facilities, adequate staff training and implications on future joint-replacement surgery. Positive findings included early involvement of Microbiology and that no cases originated from GPs performing ‘blind’ injections. Debate also exists in the literature concerning the optimal choice of sterilising agent5. Clearly, standards must be improved locally, and with the above learning points implemented we propose to re-audit.
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