Open Compared with Arthroscopic Treatment of Acute Septic Arthritis of the Native Knee

Johns, Brenton P.; Loewenthal, Mark; Dewar, David

doi:10.2106/jbjs.16.00110

Cited by 90 publications

(112 citation statements)

References 23 publications

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“…Several studies have compared arthrotomy and arthroscopic treatment for septic arthritis of knee. [10][11][12][13][14][15][16][17] To the best of our knowledge, there has not been any systematic review or meta-analysis in the English literature comparing arthrotomy and arthroscopy in the treatment of septic arthritis of the knee.…”

Section: Introductionmentioning

confidence: 99%

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Arthroscopic debridement has lower re-operation rates than arthrotomy in the treatment of acute septic arthritis of the knee: a meta-analysis

Panjwani¹,

Wong

Tan

et al. 2019

Journal of ISAKOS

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ImportanceSeptic arthritis of the native knee joint is the most common bacterial joint infection. The management involves prompt surgical debridement and joint irrigation by arthroscopy or arthrotomy. This is the first systematic review and meta-analysis to compare arthroscopic debridement with arthrotomy for septic arthritis of native knee joint.ObjectiveThe purpose of this systematic review and meta-analysis is to compare re-operation rates, length of inpatient hospital stay (LOS) and functional outcome between arthroscopy and arthrotomy in the treatment of acute septic arthritis of the native knee joint.Evidence reviewThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched from database inception to 31 May 2019. All original studies that compared re-operation rates and LOS between arthroscopy and arthrotomy for septic arthritis of knee were included. The research question and eligibility criteria were established a priori. Pertinent data were extracted and random-effects model was used to pool the data where possible.FindingsA total of seven studies with 1089 knees were included, of which 723 underwent arthroscopic surgery and 366 knees underwent arthrotomy. The relative risk of re-operation was significantly lower in the arthroscopy group with a pooled relative risk of 0.69 (95% CI 0.56 to 0.86; p=0.0006). All studies reported shorter LOS and one study reported better functional outcomes in the arthroscopy group as compared with arthrotomy. However, the data could not be quantitatively synthesised due to variation in reporting among the studies included.Conclusions and relevanceBased on the available evidence, we conclude that arthroscopy for the treatment of septic arthritis of the knee results in a lower re-operation rate than arthrotomy. It cannot be concluded whether arthroscopic treatment results in shorter LOS or better functional outcome as compared with arthrotomy.Level of evidenceIV

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Section: Introductionmentioning

confidence: 99%

“…15 However, outcomes (re-operations) based on the micro-organism isolated were not reported in any studyon September 6, 2020 by guest. Protected by copyright.…”

mentioning

confidence: 99%

Arthroscopic debridement has lower re-operation rates than arthrotomy in the treatment of acute septic arthritis of the knee: a meta-analysis

Panjwani¹,

Wong

Tan

et al. 2019

Journal of ISAKOS

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“…Urgent therapeutic measures include copious arthroscopic irrigation and lavage, synovectomy, and concomitant administration of 2 effective antibiotics (based on the antibiogram) for at least 6 weeks [32]. Johns et al [33] reported that outcomes of arthroscopic procedures were comparable with those of open surgery. Appropriate antibiotic therapy achieves effective eradication of infection in 85% of cases without any adverse effect on final function of the affected knee [34,35].…”

Section: Discussionmentioning

confidence: 99%

Knee septic arthritis caused by α-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report

et al. 2019

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Background: Arthroscopic partial meniscectomy is a common procedure in orthopedic practice. Infections are uncommon complications of this procedure with an incidence rate of 0,01% -3,4%. Staphylococcus spp are the predominant causative agents in such cases. We present a case of knee septic arthritis caused by α-hemolytic Streptococcus.Case presentation: A 22-year-old woman diagnosed with obesity (body mass index [BMI] 35 kg/m 2 ) but with no other major comorbidities underwent an arthroscopic selective meniscectomy with administration of intravenous cefazolin for antibiotic prophylaxis. After an uneventful period of 2 months, the patient returned with pain, fever and a discharging sinus at the site of anterolateral arthroscopic portal. Blood tests and magnetic resonance imaging revealed osteomyelitis involving the tibial plate. Cultures of synovial fluid obtained from the knee and a pharyngeal swab yielded α-hemolytic Streptococcus. Five days later, the patient underwent arthroscopic debridement with partial synovectomy. Intraoperative specimens yielded α-hemolytic Streptococcus. The patient received intravenous piperacillin/tazobactam, followed by an associative regimen of amoxicillin and clindamycin with clinical, laboratory and instrumental evidence of symptom resolution. Conclusion: The incidence of knee septic arthritis after arthroscopic partial meniscectomy is 0.01-3.4%. This infection is usually caused by Staphylococcus spp. and in rare cases by commensal bacteria, such as α-hemolytic streptococci, secondary to transient bacteremia. Screening of the colonized area is important to prevent possible transient bacteremia. Diagnosis is based on isolation of the causative organisms from synovial fluid cultures, and treatment comprises arthroscopic debridement with individualized systemic antibiotic therapy based on the results of an antibiogram.

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“…Cerrahi yöntemlerin değerlendirildiği Johns ve ark. 'nın (27) çalışmasında septik artit nedeniyle artroskopik ve açık cerrahi debridman yaptıkları hasta grupları karşılaştırılmış, artroskopi ve açık cerrahi gruplarında sırasıyla %50 ve %29'luk bir başarı oranı raporlanmıştır. Bir diğer çalışmada Böhler ve ark.…”

Section: Yöntemlerunclassified

“…(28) açık cerrahi grubunda, atroskopik debridman grubuna kıyasla anlamlı oranda daha yüksek ikinci operasyon ihtiyacı raporlamışlardır. Aynı çalışmalarda, septik artrit endikasyonu ile artroskopik debridman uygulanan hastaların açık debridman uygulananlara göre daha geniş eklem hareket açıklığına sahip oldukları raporlanmıştır (27,28). El bilek izole septik artrit tedavisini araştıran bir çalışmada artroskopik debridman hastanede kalış süresi ve ikinci operasyon ihtiyacı bakımından açık debridmana üstün olarak raporlanmıştır (29).…”

Section: Yöntemlerunclassified

Epidemiology, Diagnosis and Treatment of Acute Septic Arthritis in Haseki Orthopedics and Traumatology Clinic

Yıldırım¹,

Muslu²,

Muratoğlu³

et al. 2020

Haseki

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Amaç: Septik artrit, mikroorganizmalar tarafından doğrudan eklem boşluğunun invazyonu şeklinde temsil edilebilir. Çalışmamızın amacı kliniğimizde septik artrit tanısı almış olan hastaların epidemiyolojik özelliklerini ortaya koymak, tanı ve tedavi yönetimini tartışmaktır. Yöntemler: Haziran 2008 ile Aralık 2014 tarihleri arasında septik artrit tanısı almış 34 hasta retrospektif olarak tarandı. Hastaların klinik ve epidemiyolojik özellikleri, enfeksiyona sebep olan mikroorganizmalar ve tedavi seçimi analiz edildi. Bulgular: Hastaların çoğunluğu erkek (%55,9) olup ortalama yaş 42,8 idi (1-87). Diz, en sık tutulan eklemdi (%91,6). Hastaların sadece %17,6'sında ateş saptandı. Analiz edilen sinoviyal sıvı örneklerinin sadece %1,6'sında gram boyama pozitif saptandı. Çalışmaya dahil olan 34 hastanın 10'unda pozitif sinoviyal sıvı kültürü mevcuttu (%29,4). Staphylococcus aureus en sık saptanan mikroorganizmaydı. Sonuç: Gram boyama negatifliği, ateşin olmaması ve normal lökosit sayısı septik artrit tanısını dışlatmaz ancak sadece olasılığını azaltır. Örnekler, kültür negatifliği ve negatif gram boyamayı önlemek adına antibiyotik tedavisinden önce alınmalıdır. Tekrarlayan iğne aspirasyon, drenaj ve ampirik antibiyoterapi septik artrit tedavisinde akılda tutulmalıdır.

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Open Compared with Arthroscopic Treatment of Acute Septic Arthritis of the Native Knee

Abstract: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Cited by 90 publications

References 23 publications

Arthroscopic debridement has lower re-operation rates than arthrotomy in the treatment of acute septic arthritis of the knee: a meta-analysis

Arthroscopic debridement has lower re-operation rates than arthrotomy in the treatment of acute septic arthritis of the knee: a meta-analysis

Knee septic arthritis caused by α-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report

Epidemiology, Diagnosis and Treatment of Acute Septic Arthritis in Haseki Orthopedics and Traumatology Clinic

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