Abstract
There is a paucity of literature comparing the relative merits of open arthrotomy
versus arthroscopy for the surgical treatment of septic knee arthritis. The primary
goal of this study is to compare the risk of perioperative complications between these
two surgical techniques. To this end, 560 patients treated for septic arthritis of
the native knee with arthroscopy were statistically matched 1:1 with 560 patients
treated with open arthrotomy. The outcome measures included major complications, minor
complications, mortality, inpatient hospital charges, and length of stay (LOS). Major
complications were defined as myocardial infarction, cardiac arrest, stroke, deep
vein thrombosis, pulmonary embolism, pneumonia, postoperative shock, unplanned ventilation,
deep surgical site infection, wound dehiscence, infected postoperative seroma, hospital
acquired urinary tract infection, and retained surgical item. Minor complications
included phlebitis and thrombophlebitis, postprocedural emphysema, minor surgical
site infection, peripheral nerve complication, and intraoperative hemorrhage. Mortality
data were extracted from the database using the Uniform Bill patient disposition.
Complications were analyzed using univariate and multivariate logistic regression
models, whereas mean costs and LOS were compared using the Kruskal–Wallis H-test.
Major complications occurred in 3.8% of the patients in the arthroscopy cohort and
5.4% of the patients in the arthrotomy cohort (p = 0.20). Too few patients in our sample died to report based on National (Nationwide)
Impatient Sample (NIS) minimum reporting standards. Rates of minor complications were
similar for the arthroscopy and arthrotomy cohorts (12.5 vs. 13.9%; p = 0.48). Multivariate analysis did not reveal any greater risk of minor or major
complication between the two procedures. Inpatient hospital cost was similar for arthroscopy
(
= $15,917; standard deviation [SD] = 14,424) and arthrotomy ( = $16,020; SD = 18,665; p = 0.42). LOS was also similar for both arthrotomy (6.78 days, SD = 6.75) and arthroscopy
(6.24 days, SD = 5.95; p = 0.23). Patients undergoing arthroscopic treatment of septic arthritis of the knee
showed no difference in relative risk of perioperative complications, LOS, or hospital
cost compared with patients who underwent open arthrotomy.
Keywords
septic arthritis - arthroscopy - arthrotomy - complications
