Spontaneous Septic Arthritis of Canine Elbows: Twenty-One Cases

Abstract

Objective This study provides information on clinical features, diagnosis, treatment and associated risk factors of spontaneous septic elbow arthritis in the dog.

Methods Medical records between March 2007 and June 2015 were searched for cases of spontaneous septic elbow arthritis with a diagnosis based on clinical signs, arthrocentesis, cytological and microbiological analysis of elbow joint synovial fluid, radiography and outcome following treatment.

Results Twenty-one cases of septic arthritis were identified. Pre-existing osteoarthritis was present in 14/15 elbows for which diagnostic imaging was available. Although all cases had increased neutrophil count on synovial fluid cytology, culture was only positive in 12/21. Despite initial improvement in lameness scores (pre-treatment 9/10 [range: 1–10] versus post-treatment 3/10 [range: 1–5]), 11/12 had residual long-term lameness. Recurrence of infection was noted in 3/12 elbows for which long-term (>8 weeks) follow-up was available. There was an acute mortality rate of 2/21 associated with severe systemic sepsis.

Clinical Significance Septic arthritis, even in the absence of pyrexia, should be considered as a major differential diagnosis in middle aged, large breed dogs, with pre-existing elbow arthritis, that suffer an acute onset lameness, with elbow joint effusion and discomfort. Antibiotic therapy alone was effective for treatment with high initial response rates. Chronic lameness post-treatment was common, and a high rate of recurrence was seen with 3/12 dogs suffering more than one episode.

Keywords

septic arthritis - elbow - osteoarthritis - elbow dysplasia - infections

Author Contributions

Ben Mielke and Richard Meeson contributed to conception of study, study design, and acquisition of data and data analysis and interpretation. All authors drafted, revised and approved the submitted manuscript.

• References

• 1 Bubenik LJ, Smith MM. Orthopaedic infections. In: Slatter D. , ed. Textbook of Small Animal Surgery. 3rd ed. Philadelphia, PA: Saunders; 2003: 1869-1871
• 2 Greene CE, Budsberg SC. Musculoskeletal infections. In: Greene CE. , ed. Infectious Disease of the Dog and Cat. 4th ed. St. Louis, Missouri: Saunders; 2006
• 3 Bennett D, Taylor DJ. Bacterial infective arthritis in the dog. J Small Anim Pract 1988; 29: 207-230
• 4 Gristina AG, Rovere GD, Shoji H. Spontaneous septic arthritis complicating rheumatoid arthritis. J Bone Joint Surg Am 1974; 56 (06) 1180-1184
• 5 Clements DN, Owen MR, Mosley JR, Carmichael S, Taylor DJ, Bennett D. Retrospective study of bacterial infective arthritis in 31 dogs. J Small Anim Pract 2005; 46 (04) 171-176
• 6 Marchevsky AM, Read RA. Bacterial septic arthritis in 19 dogs. Aust Vet J 1999; 77 (04) 233-237
• 7 Soontornvipart K, Kohout P, Proks P. Septic arthritis in dogs: a retrospective study of 20 cases (2000–2002). Acta Vet Brno 2003; 72: 405-413
• 8 Kherani RB, Shojania K. Septic arthritis in patients with pre-existing inflammatory arthritis. CMAJ 2007; 176 (11) 1605-1608
• 9 Scharf VF, Lewis ST, Wellehan JF. , et al. Retrospective evaluation of the efficacy of isolating bacteria from synovial fluid in dogs with suspected septic arthritis. Aust Vet J 2015; 93 (06) 200-203
• 10 Brown DC. Wound infections and antimicrobial use. In: Tobias KM, Johnston SA. , eds. Veterinary Surgery Small Animal. Vol 1. St. Louis, Missouri: Elsevier Saunders; 2012: 135-139
• 11 Innes JF. Arthritis. In: Tobias KM, Johnston SA. , eds. Veterinary Surgery Small Animal. St Louis, MO: Elsevier; 2012: 1078-1111
• 12 Clements D. Arthrocentesis and synovial fluid analysis in dogs and cats. In Pract 2006; 28: 256-262
• 13 Quinn MM, Keuler NS, Lu Y, Faria ML, Muir P, Markel MD. Evaluation of agreement between numerical rating scales, visual analogue scoring scales, and force plate gait analysis in dogs. Vet Surg 2007; 36 (04) 360-367
• 14 Sumner-Smith G. Gait analysis and orthopaedic examination. In: Slatter D. , ed. Textbook of Small Animal Surgery. 2nd ed. Philadelphia, PA: WB Saunders; 1993: 1577-1586
• 15 Cook JL, Evans R, Conzemius MG. , et al. Proposed definitions and criteria for reporting time frame, outcome, and complications for clinical orthopedic studies in veterinary medicine. Vet Surg 2010; 39 (08) 905-908
• 16 Hauptman JG, Walshaw R, Olivier NB. Evaluation of the sensitivity and specificity of diagnostic criteria for sepsis in dogs. Vet Surg 1997; 26 (05) 393-397
• 17 Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet 2010; 375 (9717): 846-855
• 18 Ventura G, Gasparini G, Lucia MB. , et al. Osteoarticular bacterial infections are rare in HIV-infected patients. 14 cases found among 4,023 HIV-infected patients. Acta Orthop Scand 1997; 68 (06) 554-558
• 19 Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 1997; 56 (08) 470-475
• 20 Scharf VF, Lewis DD, Wellehan JF, Wamsley HL, Richardson R. Comparison of synovial fluid culture and 16S rRNA PCR in dogs with suspected septic arthritis. Aust Vet J 2015; 93 (06) 204-207
• 21 Omar M, Ettinger M, Reichling M. , et al. Preliminary results of a new test for rapid diagnosis of septic arthritis with use of leukocyte esterase and glucose reagent strips. J Bone Joint Surg Am 2014; 96 (24) 2032-2037
• 22 Rantakokko-Jalava K, Nikkari S, Jalava J. , et al. Direct amplification of rRNA genes in diagnosis of bacterial infections. J Clin Microbiol 2000; 38 (01) 32-39
• 23 Proot JL, de Vicente F, Sheahan DE. Analysis of lactate concentrations in canine synovial fluid. Vet Comp Orthop Traumatol 2015; 28 (05) 301-305
• 24 Montgomery RD, Long Jr IR, Milton JL, DiPinto MN, Hunt J. Comparison of aerobic culturette, synovial membrane biopsy, and blood culture medium in detection of canine bacterial arthritis. Vet Surg 1989; 18 (04) 300-303
• 25 Gibson NR, Carmichael S, Li A. , et al. Value of direct smears of synovial fluid in the diagnosis of canine joint disease. Vet Rec 1999; 144 (17) 463-465
• 26 Fitch RB, Hogan TC, Kudnig ST. Hematogenous septic arthritis in the dog: results of five patients treated nonsurgically with antibiotics. J Am Anim Hosp Assoc 2003; 39 (06) 563-566
• 27 Benzioni H, Shahar R, Yudelevitch S, Milgram J. Bacterial infective arthritis of the coxofemoral joint in dogs with hip dysplasia. Vet Comp Orthop Traumatol 2008; 21 (03) 262-266
• 28 Morrow M. Urinary tract infection as nidus for systemic spread and septic arthritis. Can Vet J 1999; 40 (09) 666-668
• 29 Al-Ahaideb A. Septic arthritis in patients with rheumatoid arthritis. J Orthop Surg 2008; 3 (33) 33
• 30 Lories RJ, Luyten FP. The bone-cartilage unit in osteoarthritis. Nat Rev Rheumatol 2011; 7 (01) 43-49
• 31 Dolganiuc A, Stavaru C, Anghel M, Baltaru D, Georgescu E, Olinescu A. The migratory and phagocytic activity of polymorphonuclear leukocytes in rheumatoid arthritis and osteoarthritis patients. Roum Arch Microbiol Immunol 2000; 59 (1-2): 43-53
• 32 Newman JH. Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis 1976; 35 (03) 198-205