Irrigation through arthroscopy vs arthrotomy in the management of septic knee arthritis

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: 1
Synopsis
25 patients with septic knee arthritis were randomized to irrigation through arthroscopy or arthrotomy. The purpose of this study was to compare the effectiveness of each method in treating initial infection, as well as outcomes during a physical examination at 7, 14, 21, and 42 days after surgery. Despite two cases Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: None disclosed
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Why was this study needed now?
Septic knee arthritis is a joint infection that can cause various sequalae if not treated early. Typical intervention includes debridement, lavage, and antibiotics to eradicate the infection and remove damaged tissue. No previous randomized controlled trials have investigated if outcomes differ between open surgery via an arthrotomy or arthroscopic surgery.
What was the principal research question?
In the treatment of septic knee arthritis, is there any significant difference in efficacy and safety between arthroscopy and arthrotomy over a minimum of 24-month follow-up?
Population: 25 patients, 16 years of age or older, with septic knee arthritis confirmed using arthrocentesis. Empirical antibiotic therapy was used in both groups; intravenous oxacillin 100-200mg/kg/day for 3 weeks and intravenous gentamicin 6mg/kg/day for 1 week during hospitalization. Following discharge, patients received oral cephalexin 500mg every 6 hours for 3 weeks. Thereafter, antibiotics were tailored to the identified infecting microorganism.
Intervention: Arthroscopy group: Patients underwent arthroscopic irrigation of the joint. Local anesthetic (2% lidocaine) was used to infiltrate the joint prior to irrigation. Irrigation was performed through a suprapatellar medial cannula, and standard medial and lateral portals were used for arthroscopic instruments. A total of 10L of 0.9% saline was used for irrigation. An intra-articular suction drain was placed after irrigation for 48 hours.
Comparison: Arthrotomy group: Patients underwent open surgery through a lateral parapatellar approach. Local anesthetic (2% lidocaine) was used to infiltrate the joint prior to irrigation. Irrigation was performed with 10L of 0.9% saline. An intra-articular suction drain was placed after irrigation for 48 hours.
Outcomes: Synovial fluid was used to diagnose infection; criteria was a total leukocyte count >100,000cell/mm^3 and 75% or more of polymorph nuclear cells. Patients underwent physical examination, including the presence/absence of pain on a visual analog scale, local warmth, redness, and knee effusion. Blood tests were used to measure haemoglobin, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP). Lysholm score and knee range of motion were used to assess functional outcome.
Methods: RCT
Time: Follow-up scheduled for 7 days, 14 days, 21 days, and 42 days, as well as at 24 months.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.