Page 90 - Clinical Manual of Small Animal Endosurgery

78 Clinical Manual of Small Animal Endosurgery

Arthroscopically assisted management of septic arthritis

Chronic septic arthritis generally requires aggressive treatment for suc-
cessful resolution of infection and traditionally open surgery has been
used to irrigate the joint and to mechanically agitate the synovium,
perform subtotal synovectomy and to remove inspissated pus and fibrin
clots. Septic arthritis should be investigated using routine laboratory
protocols for bacterial culture and sensitivity, and antimicrobial treat-
ment should be broad-spectrum, bacteriocidal and tailored to laboratory
results. Arthroscopic surgical treatment of septic arthritis is effective
using high volumes of pressurised fluid flow, preferably delivered by fluid
pump and using a motorised shaver to agitate and to remove prolifera-
tive synovium. An instrument cannula or a wide-bore egress cannula is
helpful to assist removal of fibrinous clots, blood and debris and inter-
mittent occlusion of the egress cannula is helpful to distend the joint and
elevate proliferative synovium from the field of view. Multiple portals
may be necessary to access the joint thoroughly but excessive punctures
should be avoided since these prevent distension of the joint and the
working space is impaired. Following arthroscopic synovectomy, debri-
dement and lavage, postoperative analgesia continues as necessary and
antimicrobial treatment is generally continued for at least 4 weeks and
generally for 1 week following resolution of clinical signs.

Arthroscopic surgery of the shoulder

Indications for surgical arthroscopy of the shoulder include:

• osteochondritis dissecans (or OCD),
• biceps lesions,
• treatment of glenohumeral ligament insufficiency,
• incomplete ossification of the caudal glenoid cavity,

• fracture reduction of the supraglenoid tuberosity,
• management of septic arthritis.

A standard 30° oblique arthroscope is ideally suited for shoulder arthros-
copy. A 2.4 mm arthroscope is preferable for medium-sized breeds. In the
giant breed, a long arthroscope is necessary to penetrate the joint through
the lateral shoulder musculature and the longer length and strength of
the 4.0 mm arthroscope is helpful. In small breeds, a 1.9 mm arthroscope
may be better at avoiding iatrogenic damage to articular cartilage. A basic
set of arthroscopic instruments is necessary for shoulder arthroscopy,
comprising a blunt probe, grasping forceps, a hand burr, curettes and
a switching stick. Additional instruments are necessary for some proce-
dures, including a motorised shaver and an arthroscopic electrosurgery unit.