Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: A systematic review

Abstract

Purpose Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children. Methods The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Results Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy. Conclusion Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae. Level of evidence IV

Developments in diagnosis and treatment of paediatric septic arthritis

“…Recent systematic reviews showed a clear overview of the literature on drainage techniques for septic knee and hip arthritis in children[ 5 , 6 ]. It was concluded that knee arthroscopy might have a lower risk of additional drainage procedures as compared to arthrocentesis and arthrotomy in paediatric septic knee arthritis[ 5 ]. In septic hip arthritis, arthrocentesis and arthroscopic procedures may have a higher risk of additional drainage procedures in comparison with arthrotomy.…”

“…Nonetheless, arthrotomy in septic hip arthritis might be associated with inferior outcomes on the long term[ 6 ]. However, the studies about the optimal drainage procedure of the several joints were diverse and the scientific quality was generally low[ 5 , 6 ].…”

“…The highest scores were found on day two and three. A second or third drainage procedure is not exceptional[ 5 , 6 ].…”

“…There is a need for clinical risk prediction tools of paediatric septic arthritis to be prospectively validated[ 4 ]. Furthermore, the current literature about drainage techniques of paediatric septic arthritis is diverse and the quality is generally low[ 5 , 6 ]. Future prospective studies should ideally endeavour larger numbers of patients, define an established diagnosis of acute septic arthritis, report the delay between the first symptoms and the diagnosis, randomize treatment, and provide adequate follow-up time.…”

“…In 2020, a systematic review was published that stated the test characteristics of history, physical examination and laboratory and image investigations in the evaluation for septic arthritis in children presenting with an acute nontraumatic limp[ 4 ]. Recently, we published two systematic reviews with a clear overview of the literature on drainage techniques for septic knee and hip arthritis in children[ 5 , 6 ]. In this evidence-based current concept review we therefore provide an update on the diagnostic workup and treatment of paediatric septic arthritis.…”