Arthroscopic debridement has lower re-operation rates than arthrotomy in the treatment of acute septic arthritis of the knee: a meta-analysis

Abstract

ImportanceSeptic arthritis of the native knee joint is the most common bacterial joint infection. The management involves prompt surgical debridement and joint irrigation by arthroscopy or arthrotomy. This is the first systematic review and meta-analysis to compare arthroscopic debridement with arthrotomy for septic arthritis of native knee joint.ObjectiveThe purpose of this systematic review and meta-analysis is to compare re-operation rates, length of inpatient hospital stay (LOS) and functional outcome between arthroscopy and arthrotomy in the treatment of acute septic arthritis of the native knee joint.Evidence reviewThis study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched from database inception to 31 May 2019. All original studies that compared re-operation rates and LOS between arthroscopy and arthrotomy for septic arthritis of knee were included. The research question and eligibility criteria were established a priori. Pertinent data were extracted and random-effects model was used to pool the data where possible.FindingsA total of seven studies with 1089 knees were included, of which 723 underwent arthroscopic surgery and 366 knees underwent arthrotomy. The relative risk of re-operation was significantly lower in the arthroscopy group with a pooled relative risk of 0.69 (95% CI 0.56 to 0.86; p=0.0006). All studies reported shorter LOS and one study reported better functional outcomes in the arthroscopy group as compared with arthrotomy. However, the data could not be quantitatively synthesised due to variation in reporting among the studies included.Conclusions and relevanceBased on the available evidence, we conclude that arthroscopy for the treatment of septic arthritis of the knee results in a lower re-operation rate than arthrotomy. It cannot be concluded whether arthroscopic treatment results in shorter LOS or better functional outcome as compared with arthrotomy.Level of evidenceIV

Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis

“…A similar meta-analysis evaluated arthroscopic and arthrotomy interventions in patients with septic arthritis of the knee. Seven studies with 1089 knees, in which 723 were treated with arthroscopy and 366 were treated with arthrotomy were analyzed, reporting a lower re-operation rate in patients treated with arthroscopy, while parameters such as length of hospital stay and functionality were not conclusive [33]. Unlike Panjwani et al [33], we included studies reporting the interventions of interest in other joints (shoulder, hip, wrist), finding similar results in the re-operation rate in favour of arthroscopy with a shorter hospital stay.…”

“…Arthroscopic debridement of a septic joint has the advantages of providing debridement of necrosis synovial tissue, irrigation of purulent enzymatically active material, and assessment of the joint with a minimum of operative morbidity [36]. Additionally, the arthroscopic procedure has been related to better joint functionality [33]. However, we were not able to evaluate this issue since the majority of the included studies did not report or evaluate the range of motion.…”

Incisionless Synovium and Bone Biopsy of a Painful Total Knee Arthroplasty

“…Panjawani et al 1 conducted a systematic review and meta-analysis to compare outcomes between arthroscopy and arthrotomy of septic native knees. 1 Seven studies were included, comprising 723 patients who underwent arthroscopic irrigation and debridement (I&D) and 366 patients who underwent open I&D. The relative risk of reoperation was significantly lower in the arthroscopy group, whereas the length of stay was lower in the arthroscopy group in all included studies, and one study reported better functional outcomes with arthroscopy. Furthermore, in a retrospective study of 1 50% in the arthroscopic I&D group required repeated irrigation should be listed as source 2.…”

“…1 Seven studies were included, comprising 723 patients who underwent arthroscopic irrigation and debridement (I&D) and 366 patients who underwent open I&D. The relative risk of reoperation was significantly lower in the arthroscopy group, whereas the length of stay was lower in the arthroscopy group in all included studies, and one study reported better functional outcomes with arthroscopy. Furthermore, in a retrospective study of 1 50% in the arthroscopic I&D group required repeated irrigation should be listed as source 2. In addition, the arthroscopic group underwent a lower total number of irrigation procedures and had better mean postoperative range of motion (P < .05).…”

Incisionless Knee Synovectomy and Biopsy With Needle Arthroscope and Autologous Tissue Collector

“…Panjwani et al 1 conducted a systematic review and meta-analysis to compare reoperation rates, length of stay, and functional outcome between arthroscopy and arthrotomy in septic native knees. They found 7 studies comprising 723 patients who underwent arthroscopic irrigation and debridement (I&D) and 366 who underwent open I&D. The relative risk of reoperation was significantly lower in the arthroscopy group, the length of stay was lower in the arthroscopy group in all included studies, and 1 study reported better functional outcomes with arthroscopy.…”