Knee Septic Arthritis after Arthroscopy: Incidence, Risk Factors, Functional Outcome, and Infection Eradication Rate

Abstract

Purpose Septic knee arthritis following arthroscopy is a rare but dreaded complication. Definition and management of knee deep infections are quite discussed in literature. In this review, literature regarding infections after knee arthroscopy is analyzed highlighting the incidence, causative bacteria, risk factors as well as clinical outcomes. Methods We performed a review of the literature matching the following key words: “septic arthritis” OR “infection” AND “arthroscopy” AND “knee.” Knee arthroscopic procedures, such as debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release, were considered. Complex procedures, such as ligament reconstruction, fractures, or complex cartilage repair techniques, were not included. Results Thirteen studies were included in this review. Incidence of infection ranged from 0.009 to 1.1% in patients undergoing simple arthroscopic procedures. Staphylococci are the most commonly isolated organisms from postarthroscopy infection. Use of intraoperative intra-articular steroids, smoking, obesity, male sex, diabetes, number of procedures performed during surgery, time of surgery, and tourniquet time of more than 60 minutes have been certified as risk factors for knee infection. Conclusion Postarthroscopy septic arthritis of the knee causes significant morbidity, usually requiring readmission to the hospital, at least one additional operation, and prolonged antibiotic therapy, both intravenous and oral. Prompt diagnosis and treatment are associated with a high success rate. Level of Evidence Level IV, systematic review of I-IV studies.

Epithelial tissue cut‐out following needle insertion into a joint: a potential complication during arthroscopy

“…During this study epithelial tissue cut‐out occurred in 2.9% of all needle passes through skin. This is a significantly higher rate than the reported incidence of post‐arthroscopy septic arthritis between 0.009 and 1.1% . Not every instance of epithelial tissue cut‐out is resulting in septic arthritis.…”

“…Knee arthroscopy is one of the most commonly performed orthopaedic procedures worldwide, and overall post‐operative joint infection rates are low at 0.009–1.1% . However, septic arthritis can have devastating consequences including hospital readmission, further operative intervention, prolonged antibiotic treatment and early degenerative disease . All possible methods to reduce the incidence of post‐arthroscopy septic arthritis should be explored.…”

Knee septic arthritis caused by α-hemolytic Streptococcus in a patient with a recent history of knee arthroscopy: a case report

“…Post-arthroscopic knee infections are more common in patients with obesity, smokers, patients undergoing complex procedures, men, patients with diabetes, and in procedures with time > 60 min [15][16][17][18]. Surgical site infections (SSIs) are usually caused by commensals.…”

Sham surgery: justified but practical? A systematic review of sham surgery trials in orthopaedics

“…According to Horng and Miller, 26 sham surgery should involve no more than anaesthesia and a skin incision mimicking the procedure under investigation to keep within the risk threshold of other accepted research interventions that do not offer participants direct benefits such as muscle biopsy. Seven trials exceeded this threshold through the introduction of unnecessary steps in the sham including entering the joint space and exposing participants to the risk of infection, 27 with no justification from the authors as to why this was necessary. Five trials 6,9,11,23,28 included other unnecessary steps such as irrigation, injection of anaesthetic and aspiration of synovial fluid, suggesting that these sham controls were not 'inert' but had a possible therapeutic effect.…”