Similar Efficacy of Arthroscopy and Arthrotomy in Infection Eradication in the Treatment of Septic Knee: A Systematic Review and Meta-Analysis.

Zhimin Liang,Lingli Li,Jing Wang,Xiaofan Deng

doi:10.3389/fsurg.2021.801911

Abstract

Aim: To compare the arthroscopy vs. arthrotomy for the treatment of native knee septic arthritis.Methods: Electronic databases of PubMed, Embase and Cochrane Library were searched for eligible studies. Retrospective comparative studies comparing arthroscopy or arthrotomy for patients with septic arthritis of the native knee were eligible for this review. The primary outcome was recurrence of infection after first procedure. The secondary outcomes included hospital length of stay, operative time, range of motion of the involved knee after surgery, overall complications and mortality rate,Results: Thirteen trials were included in this study. There were a total of 2,162 septic arthritis knees treated with arthroscopic debridement and irrigation, and 1,889 septic arthritis knees treated with open debridement and irrigation. Arthroscopy and arthrotomy management of the knee septic arthritis showed comparable rate of reinfection (OR = 0.85; 95% CI, 0.57–1.27; P = 0.44). No significant difference was observed in hospital length of stay, operative time and mortality rate between arthroscopy and arthrotomy management group, while arthroscopy treatment was associated with significantly higher knee range of motion and lower complication rate when compared with arthrotomy treatment.Conclusion: Arthroscopy and arthrotomy showed similar efficacy in infection eradication in the treatment of native septic knee. However, arthroscopy treatment was associated with better postoperative functional recovery and lower complication rate.

Highlights

Septic arthritis is a serious orthopedic emergency that can lead to devastating cartilage destruction and even be life threatening
No significant difference was observed in hospital length of stay between arthroscopy and arthrotomy management group (Figure 4)
The most important findings from this meta-analysis were that arthroscopy and arthrotomy showed similar efficacy in infection eradication in the treatment of native septic knee, and arthroscopy treatment was associated with better postoperative functional recovery and lower complication rate

Summary

Introduction

Septic arthritis is a serious orthopedic emergency that can lead to devastating cartilage destruction and even be life threatening. The incidence of septic arthritis is 4–10 per 100,000 people per year in western countries and the frequency is reported to increase [1,2,3,4]. The most common joint affected is knee, which is involved in about half of the septic arthritis cases [4]. The diagnosis of septic arthritis relies on clinical symptoms, laboratorial exams, elevated inflammatory markers in synovial fluid, positive culture of the joint fluid and histopathological examination. Immediate management is essential to prevent devastating cartilage destruction and sepsis. As repeated needle aspiration alone has been proved to be insufficient to eradicate the infection and should only be performed at very early stage [8, 9], arthroscopy and arthrotomy with thorough debridement and irrigation have been discussed recently and both showed reliable results [10]

Objectives

Methods

Discussion

Conclusion