Increased Rates of Opioid- and Injection Drug Use-Related Septic Knee Arthritis

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Patients were included in the analysis if they had a principal diagnosis of septic arthritis of the lower extremity and were age 15 to 64 years.
Patients were included in the analysis if they had a principal diagnosis of septic arthritis of the lower extremity and were age 15 to 64 years.

The percentage of patients with septic arthritis related to opioid or injection drug use was found to have increased from 2000 to 2013 in a study published in Clinical Orthopaedics and Related Research. In addition, this patient population was found to be at greater risk for mortality and reoperation compared with individuals with nondrug-related septic arthritis.

Using the Nationwide Inpatient Sample database from 2000 to 2013, investigators conducted a cross-sectional comparative analysis of data from 19,860 patients to determine the percentage of patients admitted for septic arthritis of the knee who used injection drugs or opioids.

Patients were included in the analysis if they had a principal diagnosis of septic arthritis of the lower extremity and were age 15 to 64 years.

Over the 14-year study, 7763 patients (8%) of all patients with septic knee arthritis had drug-related septic arthritis. From 2000 to 2013, the percentage of patients with septic arthritis who used injection drugs increased from 5% to 11%, and patients with septic arthritis were found to have 44% higher odds of using injection drugs compared with all patients within the database.

Of patients with drug-related septic knee arthritis, 1% died during hospitalization vs 0.3% of those with nondrug-related septic knee arthritis (P <.001). Those who used injection drugs were also more likely to undergo repeat arthroscopic surgery (P =.007) or open irrigation and debridement, were more likely to leave against medical advice, and had longer hospital stays (5 days longer on average) compared with those who did not use injection drugs (P <.001 for all).

The percentage of patients with drug-related septic arthritis in the 15- to 34-year and 55- to 64-year age groups increased from 2000 to 2013.

Study limitations include possible miscalculations and omissions by hospitals and the lack of long-term follow-up.

“Our results highlight the impact of the opioid epidemic on the orthopaedic patient population,” researchers said. “Orthopaedic surgeons must adequately screen for [opioid and injection drug use] among patients with septic arthritis and monitor them closely for reoperation with a low threshold to reaspirate a knee in the postoperative period.”

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Reference

Won Oh DH, Wurcel AG, Tybor DJ, Burke D, Menendez ME, Salzler MJ. Increased mortality and reoperation rates after treatment for septic arthritis of the knee in people who inject drugs: Nationwide inpatient sample, 2000-2013 [published online March 14, 2018] Clin Orthop Relat Res. doi: 10.1097/01.blo.0000534682.68856.d8

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