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

Abstract

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.

Fracture-related infection of the patella: Treatment options and outcome

“…It is unclear if an operative intra-articular debridement of the knee (with synovectomy) is necessary in all cases. Although advised in septic arthritis [42] , data on the topic in FRI of the patella is currently scarce. In our study, none of the patients presented with a septic arthritis of the knee.…”

“…Therefore, one should be cautious when performing a standard knee arthrotomy with a medial release of the patella to perform an open synovectomy in fracture cases as this could further damage the blood supply. An arthroscopic approach should be considered as an alternative [42] . In our patient cohort a synovectomy was performed in cases of recurrence and those that underwent a total patellectomy.…”

Reduced Costs, Complications, and Length of Stay After Arthroscopic Versus Open Irrigation and Débridement for Knee Septic Arthritis

“…10,18,27,28 Böhler et al in a study of 70 patients reported a notable difference between surgical method revision surgery rates (20.7% open versus 4.9% arthroscopic) as did by Peres et al in a study of 25 patients (18.2% open versus 0% arthroscopic). 16,25 Our reanalysis limited to patients with severe comorbidities (ECI $ 5) of more severe infections (presenting with sepsis) revealed no statistical differences in RFS between procedures suggesting equal effectiveness, even in patients with more severe illness.…”

Endoscopic Treatment of Stump Infection of the Residual Synovial Cavity After Through-the-Knee Amputation

“…This can either be performed using a open technique, with a joint arthrotomy, or be performed arthroscopically. The literature has demonstrated equal effectiveness of arthroscopy and arthrotomy concerning eradication of infection, with the latter being inferior regarding adverse events, such as bleeding requiring transfusion, and requiring longer hospitalization times and finally time to postsurgical reduction of inflammation 3,4,6 . In our case, we wanted to use these advantages to treat the residual stump infection of the synovial cavity of a patient with an amputated limb because, for these patients, soft-tissue conditioning is paramount.…”

“…Although the TKA stump is anatomically not a knee joint anymore, the biological behavior of a residual synovial cavity in the case of infection may be comparable 1 . For nonamputated persons, arthroscopy has the advantage of shorter hospital stay and lower complication rate such as a lower rate of reinfection, making arthroscopic irrigation superior to open surgery 3,4 . Arthroscopic techniques also lead to smaller wounds and smaller scaring, which is paramount for patients with amputated lower extremities and especially in the case of an end weight-bearing stump such as a TKA.All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional and National Research Committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.Disclosure: The Disclosure of Potential Conflicts of Interest forms are provided with the online version of the article (http://links.lww.com/JBJSCC/B971).…”