Arthroscopy versus arthrotomy for the treatment of septic knee arthritis

Johnson, Daniel J.; Butler, Bennet A.; Hartwell, Matthew J.; Fernandez, Claire E.; Nicolay, Richard W.; Selley, Ryan S.; Terry, Michael A.; Tjong, Vehniah K.

doi:10.1016/j.jor.2019.11.031

Cited by 18 publications

(20 citation statements)

References 18 publications

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“…This item was reported in seven studies [10,17,23,25,27,30,31] with a total of 8,284 patients (5692 in the arthrotomy group and 2592 in the arthroscopy group) with knee and shoulder infections. In general, a significant shorter hospitalization time was obtained in patients treated with arthroscopy (MD, 0.57 days [0.10-1.05]; p = 0.02; I 2 = 50%; Fig.…”

Section: Length Of Hospital Staymentioning

confidence: 99%

“…The range of follow-up in these studies was from 30 days up to 16.2 years. The most frequently affected joint was the knee (12 studies) [7,10,11,20,21,[25][26][27][28][29][30][31], followed by the shoulder (6 studies) [14,16,17,[22][23][24], hip (1 study) [32], and wrist (1 study) [15]. The most frequently reported infective agent was Staphylococcus aureus.…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

“…Complications were reported in six studies [14,17,28,[30][31][32] in a total of 3654 patients (1726 in the arthrotomy group and 1928 in the arthroscopy group), a total of 1058 events were reported (604 after arthrotomy and 454 after arthroscopy). Meta-analysis revealed a significant lower risk for complications after arthroscopic intervention (OR, 1.32 [1.12-1.55]; p = 0.001; I 2 = 45%; Fig.…”

Section: Complicationsmentioning

confidence: 99%

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Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis

Acosta-Olivo

Vílchez-Cavazos

Blázquez-Saldaña

et al. 2021

International Orthopaedics (SICOT)

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Purpose To evaluate the efficacy of arthrotomy, when compared with arthroscopy, in the treatment of adults with septic arthritis of any joint. Methods MEDLINE, EMBASE, and Scopus were searched to identify studies comparing arthrotomy and arthroscopy as therapeutic approaches in patients with septic arthritis of any joint. The main outcome was the re-infection rate. A metaanalysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I 2 statistic index. Results Twenty studies with 10,249 patients treated by arthrotomy or arthroscopy were evaluated. We observed a significant lower risk of re-infection (odds ratio [OR], 1.35 [95% CI, 1.16-1.58]; p = 0.0002) and complications (OR, 1.32 [95% CI, 1.12-1.55]; p = 0.001) rate as well as less hospital stay (mean difference [MD], 0.57 days [95% CI, 0.10-1.05]; p = 0.02) favouring arthroscopic intervention. The subanalysis indicated that patients with knee (OR, 1.50 [95% CI, 1.17-1.92]; p = 0.001) and shoulder (OR, 1.24 [95% CI, 1.00-1.53]; p = 0.04) septic arthritis intervened by arthrotomy had a higher risk of re-infection. A lower number of hospitalization days (MD, 0.89 days [95% CI, 0.31-1.47]; p = 0.003) and a lower risk for complications (OR, 1.26 [95% CI, 1.04-1.52]; p = 0.02) were observed in patients treated with arthroscopy after septic knee arthritis. Conclusions Available evidence suggests that patients with septic arthritis of the knee and shoulder treated by arthroscopy have less risk of re-infection than those treated by arthrotomy. The quality of the body of evidence is still insufficient to reach reliable conclusions. PROSPERO trial registration number CRD42020176044. Date registration: April 28, 2020.

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Section: Length Of Hospital Staymentioning

confidence: 99%

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Section: Complicationsmentioning

confidence: 99%

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Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis

Acosta-Olivo

Vílchez-Cavazos

Blázquez-Saldaña

et al. 2021

International Orthopaedics (SICOT)

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“…Because of its rarity, literature is insufficient in this regard, and there are no set guidelines for its management [ 2 ]. The superiority of arthroscopic versus open debridement and graft removal versus retention is yet to be established [ 3 , 4 , 5 ]. Arthroscopic debridement of the knee is usually considered a safer procedure compared to open debridement.…”

Section: Introductionmentioning

confidence: 99%

“…Arthroscopic debridement of the knee is usually considered a safer procedure compared to open debridement. Most of the literature suggests that the former is associated with lesser operative time, decreased post-operative knee stiffness, and fewer rate of intra-operative and post-operative complications [ 4 , 5 ]. However, complications such as Sudeck’s osteoarthropathy, graft rupture, and stiffness of the knee have been reported following arthroscopic debridement of the knee [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Inadvertent Debridement of the Medial Patellofemoral Ligament Following Arthroscopic Knee Surgery for Infection: A Case Report

Jain¹,

Nag²,

Roy³

2021

JOCR

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Introduction: Arthroscopic debridement of the knee is usually considered a safe procedure. There are no case reports of medial patellofemoral ligament (MPFL) injury leading to habitual dislocation of the patella following this procedure in the literature. Case Presentation: A 35-year-old male presented with complaints of habitual dislocation of the left patella, which he noticed after multiple arthroscopic surgeries of the left knee performed elsewhere. He had a history of septic arthritis of the knee following anterior cruciate ligament reconstruction, for which he underwent arthroscopic debridement of the knee twice. After a detailed evaluation, we noticed MPFL medial patellofemoral ligament injury. Conclusion: The MPFL medial patellofemoral ligament injury occurred as a result of extensive resection of the medial joint capsule while operating for septic arthritis. This rare grave surgical complication emphasizes the care one should take during arthroscopic debridement of the knee. Keywords: Knee arthroscopy, complications, pyogenic arthritis, patella, dislocation.

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Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review

McKenna,

Miller,

McAleese

et al. 2024

J. exp. orthop.

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PurposeSeptic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary objective of any treatment is complete source control. This commonly takes the form of antibiotic therapy and a washout of the infected joint by means of arthroscopy or arthrotomy. The primary aim of this review is to investigate if arthroscopic washout for native knee septic arthritis confers a lower risk of repeat procedure than arthrotomy.MethodsA systematic review and meta‐analysis was conducted of the MEDLINE, SCOPUS and the Cochrane Library data bases. The primary outcome of interest was requirement for repeat washout with all‐cause complications, length of inpatient stay and mortality secondary outcomes.ResultsA total of 17,140 subjects were included for analysis of the primary outcome, and the overall rate of repeat procedure was 14.6%. No statistical difference was found between arthroscopy and arthrotomy for repeat washout (risk ratio 0.86 [95% confidence interval, CI: 0.72–1.02], I2 = 36%). Eligible studies found in favour of arthroscopy for all‐cause complication rate (risk ratio 0.75 [95% CI: 0.6–0.93], I2 = 84%) and length of stay in hospital (mean difference −1.98 days [95% CI: −3.43 to −0.53], I2 = 84%). No statistical difference was found for the mortality rate (risk ratio 1.17 [95% CI: 0.52–2.63], I2 = 57%).ConclusionOur analysis found arthroscopy and open arthrotomy to be equivocal for repeat surgical washout in native knee septic arthritis. All‐cause complication rate and length of inpatient stay were favourable for arthroscopy with no difference noted between mortality rates.Level of EvidenceLevel III.

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Arthroscopy versus arthrotomy for the treatment of septic knee arthritis

Cited by 18 publications

References 18 publications

Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis

Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis

Inadvertent Debridement of the Medial Patellofemoral Ligament Following Arthroscopic Knee Surgery for Infection: A Case Report

Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review

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