A related commentary states that the 90-day mortality rate reported in this study is probably an underestimate of the true mortality associated with septic arthritis of the knee because the sickest patients are more likely to be managed non-operatively than operatively.
The commentary highlights that guidance issued by the British Society of Rheumatology, the British Orthopaedic Association, the British Society for Antimicrobial Chemotherapy, and the Royal College of General Practitioners on the management of hot swollen joints in adults recommends joint drainage as the optimal management strategy for septic arthritis, alongside parenteral antibiotics. These recommendations highlighted the insufficiency of evidence that arthroscopic washout is superior to needle aspiration, except at the hip joint. A decade has passed since this guidance was published, and multiple audits have since confirmed that too often patients with septic arthritis are not receiving correct basic care, including blood and synovial fluid cultures and prompt, appropriate antibiotics. The commentary states that the British Society of Rheumatology is reconvening a multidisciplinary group to issue new guidance on management of hot swollen joints, and it is hoped they will consider these new models of service delivery as one of the key areas for quality improvement.