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Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients

Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Meth...

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Autores principales: Hansen, Rehne Lessmann, Bue, Mats, Borgognoni, Anna Bertoli, Petersen, Klaus Kjær
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Copernicus GmbH 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892565/
https://www.ncbi.nlm.nih.gov/pubmed/35251903
http://dx.doi.org/10.5194/jbji-7-35-2022
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author Hansen, Rehne Lessmann
Bue, Mats
Borgognoni, Anna Bertoli
Petersen, Klaus Kjær
author_facet Hansen, Rehne Lessmann
Bue, Mats
Borgognoni, Anna Bertoli
Petersen, Klaus Kjær
author_sort Hansen, Rehne Lessmann
collection PubMed
description Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( [Formula: see text]   [Formula: see text]  26), gait difficulties ( [Formula: see text]   [Formula: see text]  10) and intermittent fever ( [Formula: see text]   [Formula: see text]  9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( [Formula: see text]   [Formula: see text]  24), computer tomography (CT) ( [Formula: see text]   [Formula: see text]  17) and/or PET-CT ( [Formula: see text]   [Formula: see text]  10), predominantly displaying bone destruction/erosion of the symphysis ( [Formula: see text]   [Formula: see text]  13), abscess ( [Formula: see text]   [Formula: see text]  12) and/or fistula ( [Formula: see text]   [Formula: see text]  5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate.
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spelling pubmed-88925652022-03-04 Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients Hansen, Rehne Lessmann Bue, Mats Borgognoni, Anna Bertoli Petersen, Klaus Kjær J Bone Jt Infect Original Full-Length Article Introduction: Septic arthritis and osteomyelitis of the pubic symphysis (SAS) are rare conditions with nonspecific symptoms leading to diagnostic delay and treatment. Aim: We draw awareness to this condition elucidating the diagnostic procedures, surgical intervention and antibiotic management. Methods: This entail a retrospective follow-up study of 26 consecutive patients, median age of 71 years (range: 48–89) surgically treated for septic arthritis of the pubic symphysis between 2009 and 2020. Patient files, diagnostic imaging and bacterial cultures were evaluated. Results: Before diagnosed with SAS, 21 of the patients had previous pelvic surgery (16 due to malign conditions, 5 due to benign conditions), while 5 of the patients were not previously operated. Median follow-up period after SAS surgery was 18.5 months (range: 8 to 144.5 months). Dominating symptoms were severe suprapubic/pubic pain ( [Formula: see text]   [Formula: see text]  26), gait difficulties ( [Formula: see text]   [Formula: see text]  10) and intermittent fever ( [Formula: see text]   [Formula: see text]  9). Diagnostic delay was between 1 and 12 months. The diagnostic imaging included magnetic resonance imaging (MRI) ( [Formula: see text]   [Formula: see text]  24), computer tomography (CT) ( [Formula: see text]   [Formula: see text]  17) and/or PET-CT ( [Formula: see text]   [Formula: see text]  10), predominantly displaying bone destruction/erosion of the symphysis ( [Formula: see text]   [Formula: see text]  13), abscess ( [Formula: see text]   [Formula: see text]  12) and/or fistula ( [Formula: see text]   [Formula: see text]  5) in the adjacent muscles. All patients underwent surgical debridement with resection of the symphysis and received a minimum of 6 weeks antibiotic treatment. Fourteen patients presented with monocultures and 4 patients with polycultures. Five patients underwent at least one revision surgery. Twenty-three patients experienced postoperative pain relief at 6 weeks follow-up, and 19 patients were ambulant without walking aids. Conclusion: SAS are rare conditions and should be suspected in patients with infection, pubic pain and impaired gait, especially after pelvic surgery. Bone infection, abscess and fistula near the symphysis can be visualized with proper imaging, most frequently with MRI. For most patients in this cohort surgical debridement combined with a minimum of 6 weeks antibiotic treatment resulted in pain relief, improved walking ability and a low recurrence rate. Copernicus GmbH 2022-02-25 /pmc/articles/PMC8892565/ /pubmed/35251903 http://dx.doi.org/10.5194/jbji-7-35-2022 Text en Copyright: © 2022 Rehne Lessmann Hansen et al. https://creativecommons.org/licenses/by/4.0/This work is licensed under the Creative Commons Attribution 4.0 International License. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/
spellingShingle Original Full-Length Article
Hansen, Rehne Lessmann
Bue, Mats
Borgognoni, Anna Bertoli
Petersen, Klaus Kjær
Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
title Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
title_full Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
title_fullStr Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
title_full_unstemmed Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
title_short Septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
title_sort septic arthritis and osteomyelitis of the pubic symphysis – a retrospective study of 26 patients
topic Original Full-Length Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8892565/
https://www.ncbi.nlm.nih.gov/pubmed/35251903
http://dx.doi.org/10.5194/jbji-7-35-2022
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