Outcome of arthroscopic drainage and debridement with continuous suction irrigation technique in acute septic arthritis

Purpose: This study analyzed the treatment effects of drain insertion in the posteromedial portal after an arthroscopic synovectomy and posterior septum resection for pyogenic arthritis. Materials and Methods: From June 2005 to December 2016, 56 cases (55 patients, 1 case of bilateral knee) were diagnosed with pyogenic arthritis and arthroscopic treatment was performed. Fourteen patients (25.0%) were identified with causative organisms. The average follow-up period was 12.3 months, and the mean age was 67.8 years old. Twenty-four cases were males and 31 cases were females. Kellgrene-Lawrence grade (K-L grade) I was 6 patients, II was 20 patients, III was 11 patients, and IV was 18 patients. Surgery was performed through six portal. The posterior septum was removed and a drainage tube was inserted from the posterior medial side to the posterior side of the joint. The Lysholm score was used after surgery for a functional evaluation. The K-L grade at the time of admission and at the last follow-up were compared for a radiological evaluation. Results: The mean normalization period of the C-reactive protein was 59.8 days (6-164 days). Intravenous antibiotics were used for an average of 37.1 days. The results of the functional evaluation revealed a mean Lysholm score of 64.5 (30-98) in a total of 56 cases. Two reoperations was performed, but the treatment was completed with same method in all patients. The K-L grade was similar at the time of surgery and at the last follow-up (p>0.05). Conclusion: The method of drain insertion in the posteromedial portal after arthroscopic synovectomy and posterior septum resection for pyogenic arthritis is an effective technique that can obtain satisfactory results by inducing proper exudate discharge.

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Treatment of Pyogenic Arthritis of the Knee Using Drainage Tube Insertion in the Posterior Compartment through the Posterior Transeptal Portal after an Arthroscopic Synovectomy

Kim

Shin

2019

J Korean Orthop Assoc

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“…[1][2][3][4] Gächter 5 has classified septic arthritis into 4 stages. Stage 1 disease includes opacity of joint fluid, redness of the synovial membrane with possible petechial bleeding, and no radiologic alterations.…”

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confidence: 99%

“…The hyaline cartilage of joint does not get exposed to the air. 2 The blood loss and postoperative scarring is also significantly lesser than arthrotomy. The less postoperative pain allows early mobilization of patients.…”

mentioning

confidence: 99%

“…The less postoperative pain allows early mobilization of patients. 2,4,[9][10][11] Repeated arthroscopic debridement and drainage is needed in case of delayed treatment with advanced arthroscopic stage of the infection, early unfavorable course, or multidrug-resistant germ. 1,6,[11][12][13][14] In these situations, synovectomy should be as complete as possible to maximize the reduction of the bacterial burden and avoid the need of further debridement.…”

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confidence: 99%

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Complete Arthroscopic Synovectomy in Management of Recalcitrant Septic Arthritis of the Knee Joint

Lui¹

2017

Arthroscopy Techniques

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Septic arthritis of the knee is a potentially life-threatening condition and can be associated with many late complications. The key of success of management of septic arthritis of the knee joint is early aggressive treatment of surgical debridement and decompression and antibiotic therapy. In adults, arthroscopic drainage with synovectomy is the treatment of choice in septic arthritis of the knee, with lower rates of infectious recurrence than needle aspiration and better functional results than open surgery. Repeated arthroscopic debridement and drainage is needed in case of delayed treatment with an advanced arthroscopic stage of the infection, early unfavorable course, or multiresistant germ. In these situations, synovectomy should be as complete as possible to maximize the reduction of the bacterial burden and avoid the need of further debridement. The purpose of this Technical Note is to describe the details of complete arthroscopic synovectomy of the knee joint. This includes 2 circles of circumferential synovectomy. One circle is in the axial plane and includes the intercondylar notch, anterior, posterior, medial, and lateral compartments. The other circle is in the coronal plane and includes the supra-patellar pouch, medial and lateral recesses, and the anterior compartment.

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“…화농성 슬관절염에 대한 관절경적 변연절제술은 고식적 관 절막 절개술에 비해 즉각적인 합병증이 더 적고, 비슷한 치료결 과를 보인다는 보고가 있으며, 9) 화농성 슬관절염은 단독 관절경 적 치료보다 지속 세척술을 함께 시행한 경우 치료 효과가 더 좋 다는 보고도 있다. 10,11) 하지만 치료 실패한 화농성 슬관절염의 치 료 방법에 대한 연구는 아직 확립되어 있지 않고, 일부 연구에서 반복적인 관절경적 치료를 보고하고 있는 실정이다. 12,13) 결과: 14예 중 12예(85.7%)에서 증상 호전을 보였다.…”

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The Efficacy of Arthroscopic Debridement with Continuous Irrigation in Failed Arthroscopic Debridement for Septic Arthritis of the Knee

Jeon

Moon

Son

et al. 2016

J Korean Orthop Assoc

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Purpose:The purpose of this study is to evaluate the efficacy of arthroscopic debridement with continuous irrigation in patients with septic arthritis of the knee after failed primary arthroscopic treatment. Materials and Methods: Among 69 patients undergoing arthroscopic debridement for septic arthritis of the knee from March 2008 to March 2013, 14 patients (5 male, 9 female; mean age, 68.9±11.3 years) with failed arthroscopic debridement for septic arthritis of the knee were reviewed retrospectively (mean follow-up period, 49.2±23.2 months). All 14 patients underwent re-do of the arthroscopic debridement, then continuous irrigation. Continuous irrigation following arthroscopic debridement was maintained for a mean 8.4±2.5 days. For clinical evaluation, Lysholm knee score and visual analogue scale (VAS) were used at 1 month, 3 months, and 12 months after surgery. During the entire follow-up period, recurrence of infection and operation-related complication were also assessed. Results: Symptom improvement was observed in 12 cases (85.7%) of the 14 cases. Lysholm knee score was improved from 36.1±7.9 to 84.2±9.2 at 12 months after surgery (p＜0.05). VAS was improved from 8.9±1.3 to 2.1±1.2 at 12 months after surgery (p＜0.05). Synovial fluid cultures yielded positive findings in 9 of the 14 cases with the same bacteria in primary surgery. During the follow-up period, septic arthritis relapsed in 2 of the 5 cases with negative finding of cultures. After reoperation was performed in those 2 cases, no recurrence was observed to final follow-up. There was no complication related operation in any cases. Conclusion: Arthroscopic debridement combined with continuous irrigation is a safe and effective procedure for failed arthroscopic debridement for septic arthritis of the knee.

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Outcome of arthroscopic drainage and debridement with continuous suction irrigation technique in acute septic arthritis

Abstract: Early arthroscopic decompression and debridement of septic arthritis with continuous suction irrigation can eradicate the infection. The duration of intravenous antibiotics and the hospital stay required is shorter. The functional outcome of joints is satisfactory.

Cited by 21 publications

References 18 publications

Treatment of Pyogenic Arthritis of the Knee Using Drainage Tube Insertion in the Posterior Compartment through the Posterior Transeptal Portal after an Arthroscopic Synovectomy

Treatment of Pyogenic Arthritis of the Knee Using Drainage Tube Insertion in the Posterior Compartment through the Posterior Transeptal Portal after an Arthroscopic Synovectomy

Complete Arthroscopic Synovectomy in Management of Recalcitrant Septic Arthritis of the Knee Joint

The Efficacy of Arthroscopic Debridement with Continuous Irrigation in Failed Arthroscopic Debridement for Septic Arthritis of the Knee

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