Arthroscopic Treatment Shows Noninferior Outcomes to Open Treatment for Native Glenohumeral Septic Arthritis: A Systematic Review.

PURPOSE: To evaluate the efficacy of arthroscopic versus open treatment of native glenohumeral septic arthritis (not including prosthetic joint infections), both in terms of reinfection rates and postoperative functional outcomes.

METHODS

PubMed and Embase/Medline were searched from date of inception to July 26, 2025, for articles comparing arthroscopic versus open treatment of native glenohumeral septic arthritis. Cohort studies reporting outcomes of both arthroscopic and open treatment for glenohumeral septic arthritis were included. A meta-analysis comparing the primary outcome between using arthroscopy and arthrotomy for glenohumeral septic arthritis was not performed due to low level of evidence of included comparative studies. The primary outcome of interest in this study was reoperation or reinfection rates. Secondary outcomes analyzed included mortality rate, length of hospital stay, 30-day all-cause complications, cost, and functional outcomes.

RESULTS

Nine articles comprising 10,352 patients with glenohumeral septic arthritis were included, including 4250 patients in the arthroscopic treatment arm (mean age 63.2 ± 16.3 years) and 6102 patients in the open treatment arm (mean age 60.9 ± 18.7 years). Notably, reinfection rates showed considerable heterogeneity, particularly in the arthroscopic group, with reinfection rates ranging from 7.46% to 75.0% compared with the narrower range of 12.6% to 22.2% in the open treatment group. Thirty-day all-cause complication rates ranged from 15.7% to 47.5% in patients undergoing arthroscopic treatment versus 22.6% to 50.5% in patients undergoing open treatment. In the arthroscopic treatment group, mortality rates ranged from 2.09% to 4.76%, while mortality rates in the open treatment arm were between 3.47% and 7.0%.

CONCLUSIONS

Current evidence comparing arthroscopic versus open treatment of glenohumeral septic arthritis shows mixed results with substantial heterogeneity in reinfection rates. While arthroscopic treatment showed lower 30-day all-cause complications and blood transfusion requirements, the wide variation in outcomes prevents definitive conclusions about treatment superiority.

LEVEL OF EVIDENCE: Level IV, systematic review of Level III and IV studies.