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J Knee Surg 2023; 36(09): 949-956
DOI: 10.1055/s-0042-1747948
Original Article

Comparison of Arthroscopy versus Open Arthrotomy for Treatment of Septic Arthritis of the Native Knee: Analysis of 90-Day Postoperative Complications

Alexander Dobek 
1   Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Jordan Cohen
2   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
,
Pradip Ramamurti
3   Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia
,
Alex Gu 
1   Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Gregory J. Golladay
4   Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia
,
Teresa Doerre
1   Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
,
Savyasachi Thakkar
5   Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, Maryland
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Abstract

Septic arthritis is an orthopaedic emergency, often necessitating surgical debridement, and the knee joint is most frequently affected. Arthroscopic and open irrigation and debridement (I&D) are the two commonest surgical treatments for septic arthritis of the native knee. Several studies have compared outcomes of open and arthroscopic management without coming to a clear conclusion which yields superior outcomes. The purpose of this study was to compare the results of these two surgical techniques to treat septic arthritis of the native knee using a large nationwide database. Patients who underwent arthroscopic or open I&D as treatment for knee septic arthritis from 2010 to 2019 were identified using a national insurance database. The primary outcome was the 90-day reoperation rate. Secondary outcomes included surgical site infection, readmission, and other postoperative complications. A total of 1,139 patients were identified, 618 of whom (54%) underwent open treatment and 521 (46%) underwent arthroscopic treatment. The two groups did not differ significantly by age, gender, or most comorbidities. There was no significant difference in 90-day reoperation rate between the groups (15.0.% open and 18.0% arthroscopic, p = 0.174). Patients who underwent open treatment had increased odds of readmission to the hospital (odds ratio [OR] = 1.46 [1.14–1.86]; p = 0.003), postoperative anemia (OR = 1.71 [1.08–2.75]; p = 0.025), and blood transfusion (OR = 1.76 [1.04–3.06]; p = 0.040) compared with those who underwent arthroscopic surgery. Using administrative claims data, we found that arthroscopic and open I&D have similar rates of reoperation and most 90-day postoperative outcomes. Lower rates of readmission, postoperative anemia, and blood transfusion were found with arthroscopic I&D, suggesting that arthroscopy may be preferable to open treatment in the management of septic arthritis of the native knee in cases in which other case- and surgeon-specific factors do not otherwise dictate the best treatment modality.

Keywords

infection - knee - acute

Note

The reaserch was done at the George Washington University School of Medicine and Health Sciences.




Publication History

Received: 29 November 2021

Accepted: 25 February 2022

Article published online:
05 May 2022

© 2022. Thieme. All rights reserved.

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  • References

  • 1 Newman JH. Review of septic arthritis throughout the antibiotic era. Ann Rheum Dis 1976; 35 (03) 198-205
    CrossrefPubMedGoogle Scholar
  • 2 Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA. Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 1997; 56 (08) 470-475
    CrossrefPubMedGoogle Scholar
  • 3 Roerdink RL, Huijbregts HJTAM, van Lieshout AWT, Dietvorst M, van der Zwaard BC. The difference between native septic arthritis and prosthetic joint infections: a review of literature. J Orthop Surg (Hong Kong) 2019; 27 (02) 2309499019860468
    CrossrefPubMedGoogle Scholar
  • 4 Smith JW, Chalupa P, Shabaz Hasan M. Infectious arthritis: clinical features, laboratory findings and treatment. Clin Microbiol Infect 2006; 12 (04) 309-314
    CrossrefPubMedGoogle Scholar
  • 5 Goldenberg DL. Septic arthritis. Lancet 1998; 351 (9097): 197-202
    CrossrefPubMedGoogle Scholar
  • 6 Elsissy JG, Liu JN, Wilton PJ, Nwachuku I, Gowd AK, Amin NH. Bacterial septic arthritis of the adult native knee joint: a review. JBJS Rev 2020; 8 (01) e0059
    CrossrefPubMedGoogle Scholar
  • 7 Mathews CJ, Weston VC, Jones A, Field M, Coakley G. Bacterial septic arthritis in adults. Lancet 2010; 375 (9717): 846-855
    CrossrefPubMedGoogle Scholar
  • 8 Bovonratwet P, Nelson SJ, Bellamkonda K. et al. Similar 30-day complications for septic knee arthritis treated with arthrotomy or arthroscopy: an American College of Surgeons National Surgical Quality Improvement Program Analysis. Arthroscopy 2018; 34 (01) 213-219
    CrossrefPubMedGoogle Scholar
  • 9 Kerbel YE, Lieber AM, Kirchner GJ. et al. In-hospital complications following arthrotomy versus arthroscopy for septic knee arthritis: a cohort-matched comparison. J Knee Surg 2021; 34 (01) 74-79
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Faour M, Sultan AA, George J. et al. Arthroscopic irrigation and debridement is associated with favourable short-term outcomes vs. open management: an ACS-NSQIP database analysis. Knee Surg Sports Traumatol Arthrosc 2019; 27 (10) 3304-3310
    CrossrefPubMedGoogle Scholar
  • 11 Kalem M, Sahin E. Comparison of three surgical treatment methods in acute septic arthritis of the knee in adults. Flora J Infect Diseases Clin Microbiol 2018; 23 (02) 64-72
    CrossrefPubMedGoogle Scholar
  • 12 Peres LR, Marchitto RO, Pereira GS, Yoshino FS, de Castro Fernandes M, Matsumoto MH. Arthrotomy versus arthroscopy in the treatment of septic arthritis of the knee in adults: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3155-3162
    CrossrefPubMedGoogle Scholar
  • 13 Böhler C, Dragana M, Puchner S, Windhager R, Holinka J. Treatment of septic arthritis of the knee: a comparison between arthroscopy and arthrotomy. Knee Surg Sports Traumatol Arthrosc 2016; 24 (10) 3147-3154
    CrossrefPubMedGoogle Scholar
  • 14 Johns BP, Loewenthal MR, Dewar DC. Open compared with arthroscopic treatment of acute septic arthritis of the native knee. J Bone Joint Surg Am 2017; 99 (06) 499-505
    CrossrefPubMedGoogle Scholar
  • 15 Wirtz DC, Marth M, Miltner O, Schneider U, Zilkens KW. Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy. Int Orthop 2001; 25 (04) 239-241
    CrossrefPubMedGoogle Scholar
  • 16 Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998; 36 (01) 8-27
    CrossrefPubMedGoogle Scholar
  • 17 Dunn OJ. Multiple comparisons among means. J Am Stat Assoc 1961; 56 (293) 52-64
    CrossrefPubMedGoogle Scholar
  • 18 Cappellini MD, Motta I. Anemia in clinical practice-definition and classification: does hemoglobin change with aging?. Semin Hematol 2015; 52 (04) 261-269
    CrossrefPubMedGoogle Scholar
  • 19 Acosta-Olivo C, Vilchez-Cavazos F, Blázquez-Saldaña J, Villarreal-Villarreal G, Peña-Martínez V, Simental-Mendía M. Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis. Int Orthop 2021; 45 (08) 1947-1959
    CrossrefPubMedGoogle Scholar
  • 20 Allaudeen N, Vidyarthi A, Maselli J, Auerbach A. Redefining readmission risk factors for general medicine patients. J Hosp Med 2011; 6 (02) 54-60
    CrossrefPubMedGoogle Scholar
  • 21 Zilberberg MD, Shorr AF, Micek ST, Kollef MH. Risk factors for 30-day readmission among patients with culture-positive severe sepsis and septic shock: a retrospective cohort study. J Hosp Med 2015; 10 (10) 678-685
    CrossrefPubMedGoogle Scholar
  • 22 Johnson DJ, Butler BA, Hartwell MJ. et al. Arthroscopy versus arthrotomy for the treatment of septic knee arthritis. J Orthop 2019; 19: 46-49
    CrossrefPubMedGoogle Scholar
  • 23 Stutz G, Kuster MS, Kleinstück F, Gächter A. Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 2000; 8 (05) 270-274
    CrossrefPubMedGoogle Scholar
  • 24 Jensen K, Klein W, Dann K. Arthroscopic treatment of septic gonitis. Arthroskopie 1989; 2: 104-111
    PubMedGoogle Scholar