Arthroscopic versus open irrigation and debridement in native knee septic arthritis: A retrospective review

Theodore L Schoenfeldt; Madeline M Lyons; Fahad Sarvari; Carlo Eikani; Daniel R Schmitt; Nicholas M Brown

doi:10.1016/j.jcot.2023.102254

Arthroscopic versus open irrigation and debridement in native knee septic arthritis: A retrospective review

J Clin Orthop Trauma. 2023 Sep 22:44:102254. doi: 10.1016/j.jcot.2023.102254. eCollection 2023 Sep.

Authors

Theodore L Schoenfeldt¹, Madeline M Lyons¹, Fahad Sarvari², Carlo Eikani², Daniel R Schmitt¹, Nicholas M Brown¹

Affiliations

¹ Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
² Loyola University Chicago Stritch School of Medicine, Maywood, IL, USA.

PMID: 37817762
PMCID: PMC10561059 (available on 2024-09-22)
DOI: 10.1016/j.jcot.2023.102254

Abstract

Introduction: Native knee septic arthritis is a rare condition with a potential for high morbidity if not promptly treated. Treatment involves surgical decompression of the affected joint along with systemic antibiotic therapy. The purpose of this study is to compare arthroscopic versus open irrigation and debridement for treatment of native knee septic arthritis.

Methods: A retrospective review was conducted at a single academic institution of all patients treated for native knee septic arthritis from January 2007 until August 2018 utilizing ICD and CPT codes. Patient demographics, type of surgical procedure, need for reoperation, laboratory values, length of stay, and comorbidities were compared.

Results: A cohort of sixty-six patients who underwent 85 surgeries were included. Among these surgeries, 52 (61%) were arthroscopic while 33 (39%) were open arthrotomies, and 21% required more than one operation. While not statistically significant, the odds of reoperation was higher for those that underwent arthroscopic compared to open irrigation and debridement on univariable (OR = 4.05, p = .08) and multivariable analysis (OR = 4.39, p = .10). Additionally, patients were more likely to require a longer hospital stay if they initially underwent arthroscopic rather than open debridement (RR = 1.31, p = .02).

Conclusion: Native knee septic arthritis can be treated with a single surgery in the majority of cases. In our sample, there was an increased odds of reoperation in those treated arthroscopically compared to open, though this finding was not statistically significant. We found longer length of stay for patients undergoing arthroscopic rather than open irrigation and debridement - even after controlling for multiple operations, culture status, sex, age, and comorbidities.

Keywords: Arthroplasty; Irrigation and debridement; Septic arthritis.