Abstract Introduction: Native septic arthritis (SA) is rare, with an estimated annual incidence of 2 per 100,000 individuals. It poses a significant clinical burden due to rapid joint destruction and long-term functional impairment. This study presents a retrospective review of native knee, hip, and shoulder SA treated at a single academic medical center. The primary objective was to characterize the clinical, demographic, and microbiologic features of affected patients and to evaluate associations between patient-specific factors and the need for repeat surgical irrigation and debridement (I&D). Methods: This retrospective case series included patients with native SA of the knee, hip, and shoulder treated at a single academic institution between January 1, 2014, and December 31, 2022. Demographics, comorbidities, laboratory data, and culture results were collected for all cohorts. The analysis focused on identifying predictors for reoperation in the knee, hip, and shoulder cohorts. Results: Among the 62 knee cases, 48% had diabetes, with culture positivity observed in 54%. A formal I&D was performed in 97%, with 32% requiring repeat procedures. Multivariate analysis identified culture positivity (odds ratio OR 9.43, P = 0.02) and diabetes (OR 8.0, P = 0.03) as independent predictors of reoperation. Male gender was associated with decreased odds of reoperation (OR 0.18, P = 0.02). In the hip and shoulder cohorts, no significant predictors were found. Conclusion: Native SA at our institution is associated with significant comorbidities and treatment failure. In this study, diabetes mellitus and culture positivity were independently associated with increased odds of reoperation, whereas male gender was independently associated with decreased odds of reoperation in knee infections. Staphylococcus aureus was the most common pathogen across all joints. These findings highlight the importance of host and microbiologic factors in determining reoperation risk. Further studies are needed to validate these predictors across larger cohorts.
McDaniel et al. (Wed,) studied this question.