TOPLINE:

In real-world practice, bedside needle arthroscopy performed under local anesthesia successfully treated 86% of patients with confirmed or suspected native joint bacterial arthritis, avoiding the need for general anesthesia or conventional surgery.

METHODOLOGY:

• Researchers conducted a 30-month prospective study in Netherlands to evaluate the potential of bedside needle arthroscopy under local anesthesia as a minimally invasive approach for rapid diagnosis and joint lavage in patients with suspected or confirmed native joint bacterial arthritis in real-world clinical practice.
• They included 42 patients (mean age 67 years; 69% male) with 44 native joints with confirmed or highly suspected bacterial arthritis; the knee was the most involved joint (77%). Participants were selected on the basis of a positive synovial fluid culture or the presence of at least two local signs of joint inflammation and at least one systemic sign.
• Patients underwent bedside debridement with a 2-mm needle arthroscope, received intravenous antibiotics after joint aspiration, and were followed for at least 3 months.
• The primary outcome was reoperation within 30 days; secondary outcomes included intervention rates, mortality, procedure metrics, and patient-reported outcomes at 3 months.

TAKEAWAY:

• Only 14% (95% CI, 5%-27%) of joints required reoperation (conventional arthroscopy or conventional arthrotomy) within 30 days; the overall reintervention rate was 23%.
• Patient-reported outcomes showed significant improvement in EuroQol 5-Dimension 5-Level Questionnaire scores from baseline (median, 0.073) to 3-month follow-up (median, 0.81; P < .001).
• The identified risk factors for the failure of single debridement included an elevated baseline erythrocyte sedimentation rate (112 mm/h vs 57 mm/h; P = .027) and the presence of purulent synovial fluid (67% vs 11%; P = .011).
• Staphylococcus aureus emerged as the most frequently identified pathogen (36%) in positive cultures.

IN PRACTICE:

“Bedside needle arthroscopy successfully controlled infection in 86% of cases under local anesthesia. This is of high clinical relevance, as timely treatment not only reduces the immediate risk of joint destruction but also prevents the development of secondary osteoarthritis,” the authors of the study wrote.

SOURCE:

The study was led by Alex B. Walinga, MD, Department of Orthopedic Surgery and Sports Medicine, Amsterdam University Medical Center, Amsterdam, Netherlands. It was published online on November 27, 2025, in Arthritis Research & Therapy.

LIMITATIONS:

The study’s limitations include its modest sample size and being conducted in only two hospitals, which may affect generalizability. The 43% positive culture rate raises considerations about diagnostic accuracy in bacterial arthritis. Additionally, some patients with other joint pathologies may have been included due to symptom overlap.

DISCLOSURES:

Two authors reported receiving grants from the Amsterdam UMC Innovation Committee and Arthrex GmbH to support this study. One author disclosed serving as a paid consultant for Arthrex, outside the submitted work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.