Arthroscopic Partial Synovectomy And Joint Lavage In The Treatment Of Septic Arthritis In Bovines
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Date
2007
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Tamil Nadu Veterinary and Animal Sciences University
Abstract
Thirty six clinical cases of bovines with septic arthritis were randomly
divided into three groups of 12 animals each and treated by conventional lavage
(group I), arthroscopic fibrin debridement and lavage (group II) and arthroscopic
debridement, partial synovectomy and lavage (group III). The incidence of septic
arthritis was more frequent in crossbred, heifer calves as a sequela to
omphalophlebitis. A mean lameness score of 3.58, 3.67 and 3.83 observed on day 1
decreased to 1.83, 1.17 and 1.00 on the 10 th day in group I, II and III respectively.
The purulent or turbid synovial fluid observed on day 1 became clear and
viscous on day 14 in 23.81, 90.48 and 100 per cent samples of group I, II and III
respectively. Significantly increased synovial fluid volume and total protein content
recorded on day 1 returned to its normal value on day 21 in group I and on day 14
in both group II and III. The raised synovial fluid alkaline phosphatase activity,
serum and synovial fluid glucose difference, total nucleated cell count noted on day
1 returned to their base value on days 28, 21 and 14 in group I, II and III
respectively.
Synovial fluid culture was positive in 58.73 per cent of joints and the
bacteria isolated were Streptococcus spp., Escherichia coli, Pseudomonas spp.,
Staphylococcus spp. and Salmonella spp. A combination of amikacin and penicillin
or ampicillin provided broad-spectrum coverage against majority of the bacterial
isolates.Soft tissue swelling, increased joint space, intra-articular gas shadow and
subchondral osteolysis were the salient radiographic findings. Hyperaemia,
petechial haemorrhage, degeneration/necrosis in synovial membrane, thickening
and clubbing of villi, articular cartilage erosion, and fibrin deposits or free floating
fibrin clots were the major arthroscopic findings. Fibrin deposits and bacterial
colonies in synovial membrane and articular cartilage were the major histological
changes.
The outcome was sound, acceptable and unacceptable respectively in 66.67,
14.28 and 19.05 percent joints of group I animals whereas it was sound in 95.24 per
cent joints and acceptable in 4.76 percent joints of both groups II and III. The mean
time taken for resolution of joint infection was 18.11, 13.33 and 11.13 days in
group I, II and III respectively.
It is concluded that arthroscopy permits thorough evaluation, appropriate
debridement and effective lavage of septic joints with minimal tissue trauma and
offers consistently good results in the management of septic arthritis in bovines than
conventional lavage. Partial synovectomy is recommended during arthroscopic
debridement of septic joints to eliminate colonizing bacteria and as it helps to
shorten the recovery period. Needle lavage is recommended for cases that are
presented within 5 to 6 days after infection and arthroscopy for cases presented 7
days or more after onset of clinical signs and those which were refractory to
conventional treatment.