Postoperative septic arthritis after elective equine arthroscopy without antimicrobial prophylaxis.
Authors: Borg Hanna, Carmalt James L
Journal: Veterinary surgery : VS
Summary
# Editorial Summary: Postoperative Septic Arthritis After Elective Equine Arthroscopy Joint sepsis remains a concern following arthroscopic surgery, yet uncertainty exists about whether antimicrobial prophylaxis is essential for routine elective procedures. Borg and Carmalt reviewed 444 consecutive arthroscopic cases performed between 2008–2010 without prophylactic antimicrobial coverage, examining 636 joints across various locations and recording postoperative complications including fever, infections, and septic joints. Septic arthritis developed in only 3 of 444 horses (0.7% of cases) affecting 3 of 636 joints (0.5%), with all affected horses surviving and returning to function; this infection rate compared favourably to published data citing 0.9% sepsis regardless of whether horses received no antimicrobials or perioperative prophylaxis. The broader complication profile was also reassuring, with only 20 documented complications across all procedures, suggesting that elective arthroscopy in healthy horses without systemic disease carries a relatively low intrinsic infection risk. These findings may prompt reconsideration of blanket antimicrobial prophylaxis protocols for routine elective cases, though practitioners should note this cohort likely excluded high-risk patients and that case selection, operative technique, and aseptic discipline remain paramount in minimising postoperative joint infections.
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Practical Takeaways
- •Elective arthroscopy appears safe without routine prophylactic antimicrobials based on this large series, though individual risk assessment and surgical technique remain critical
- •Close postoperative monitoring for fever and limb swelling is essential, as these were the earliest signs of complications in this cohort
- •Proper postoperative bandaging technique matters—2 cases involved complications from inappropriate bandaging, highlighting the importance of wound management protocols
Key Findings
- •Septic arthritis occurred in 0.5% of joints (3 cases in 636 joints explored) and 0.7% of horses (3 of 444) following elective arthroscopy without antimicrobial prophylaxis
- •Only 20 complications occurred across 444 arthroscopic procedures (4.5% complication rate), with fever being the most common (n=9)
- •Infection rate of 0.5-0.7% without prophylactic antimicrobials compares favorably to reported rates of 0.9% in horses receiving prophylactic antimicrobials
- •All horses with septic joints survived and returned to function