Daily needle aspiration versus surgical lavage for the treatment of bacterial septic arthritis in adults

Septic arthritis is a substantial public health problem, accounting for 0.2-0.7% of hospital admissions. However, despite the availability of effective antibiotics, the appropriate approach to adjunctive therapy remains controversial. Although early drainage is essential to minimize the risks of permanent loss of articular function, it is unclear whether the optimal approach involves arthroscopic lavage or daily arthrocentesis; surgeons appear to prefer surgical lavage because their training routinely considers septic arthritis to be a closed-space infection comparable to an abscess, whereas rheumatologists appear to prefer daily arthrocentesis because of its ease and non-invasive nature. There is a paucity of prospective data comparing the two approaches, and the literature is largely retrospective. Herein, we review the available literature concerning drainage of bacterially infected joints, and conclude that in the absence of prospective randomized clinical trials, the best evidence suggests that there is no compelling reason to recommend surgical lavage for the initial management of uncomplicated septic arthritis.