Surgical Treatment of the Sternoclavicular Joint Disease and SAPHO Syndrome

Objective: The rare SAPHO syndrome is associated with synovitis, acne, pustulosis, hyperostosis, and osteitis of the sternoclavicular joint (SCJ). The disease of the SCJ refers to a wide spectrum of pathogenetic processes encountered in the clinical praxis. Until now, there is no standard treatment approach as evidence is limited to case reports and small series. We assess our results using a standard surgical treatment algorithm for different forms of medically refractory disease of the SCJ.

Methods: We analyzed all patients with sternoclavicular joint disease introduced to our department of thoracic surgery since 2013. After surgical treatment all patients were kept in follow-up.

Results: In our institution, we operated 11 consecutive patients between May 2013 and July 2018, who presented with a painful SCJ and medically refractory chronic infection. Patients were 58 ± 5 years of age (64% male). First step of our approach consists incision, drainage, and joint resection. Vacuum therapy and extensive resection followed in most cases (10/11) as primary wound closure was not possible or successful. Our surgical treatment algorithm leads to complete restitution in all patients. In long-term follow-up, no patient showed a persistent infection, pain, or significant restriction in range of motion.

Conclusion: Our multimodal treatment approach is a stable algorithm that applies to the most clinical scenarios independent of the etiology and natural process of each form of the SCJ disease with a high success rate. Further studies and risk stratification models are needed in order to adopt the proposed algorithm as a treatment consensus.

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