Similar Efficacy of Arthroscopy and Arthrotomy in Infection Eradication in the Treatment of Septic Knee: A Systematic Review and Meta-Analysis

Abstract

Aim: To compare the arthroscopy vs. arthrotomy for the treatment of native knee septic arthritis.Methods: Electronic databases of PubMed, Embase and Cochrane Library were searched for eligible studies. Retrospective comparative studies comparing arthroscopy or arthrotomy for patients with septic arthritis of the native knee were eligible for this review. The primary outcome was recurrence of infection after first procedure. The secondary outcomes included hospital length of stay, operative time, range of motion of the involved knee after surgery, overall complications and mortality rate,Results: Thirteen trials were included in this study. There were a total of 2,162 septic arthritis knees treated with arthroscopic debridement and irrigation, and 1,889 septic arthritis knees treated with open debridement and irrigation. Arthroscopy and arthrotomy management of the knee septic arthritis showed comparable rate of reinfection (OR = 0.85; 95% CI, 0.57–1.27; P = 0.44). No significant difference was observed in hospital length of stay, operative time and mortality rate between arthroscopy and arthrotomy management group, while arthroscopy treatment was associated with significantly higher knee range of motion and lower complication rate when compared with arthrotomy treatment.Conclusion: Arthroscopy and arthrotomy showed similar efficacy in infection eradication in the treatment of native septic knee. However, arthroscopy treatment was associated with better postoperative functional recovery and lower complication rate.

Arthroscopy or arthrotomy for native knee septic arthritis: A systematic review

“…Therefore, the overall conclusion of this review is that neither arthroscopy nor arthrotomy showed superiority in reducing reoperation rate. This aligns with findings of previous reviews of this subject [ 11 , 28 , 38 ] with the exception of Acosta‐Olivo et al [ 2 ] who found that arthroscopic washout was superior.…”

“…The surgical washout of a joint can either take the form of arthroscopy or arthrotomy. Contradictory conclusions have been drawn from prior reviews regarding the efficacy of arthroscopy in eradicating infection [ 2 , 28 ]. There is also no consensus on the functional and clinical results associated with both procedures for various patient cohorts.…”

Does arthroscopic or open washout in native knee septic arthritis result in superior post-operative function? A systematic review and meta-analysis of randomised controlled trials and observational studies.

“…The present study represents the rst systematic review focusing primarily on function following AW and OW. Our ndings agree with PROMs and ROM described in reviews by Panjwani (13) and Liang (12) , respectively. This was predictable, as we retrieved just one additional study reporting PROMs (26) , and none further reporting ROM.…”

“…However, the con dence intervals were imprecise suggesting heterogeneity, so the results should be interpreted cautiously. In keeping with our ndings, Liang (12) showed a possible trend for lower rates of reinfection following AW (OR = 0.85; p = 0.44), whilst Panjwani (13) reported substantially reduced risk of re-operation (RR = 0.69; p = 0.0006). Both these reviews included additional studies in their pooled analyses which were excluded from the present study due to omission of PROMs (35)(36)(37)(38)(39) .…”

“…We hypothesised that AW would be associated with favourable post-operative PROMs and ROM, owing to smaller incisions and reduced scarring. We also hypothesised that AW would be associated with as good, or superior, rates of infection eradication, in keeping with previous meta-analyses (12,13) . Therefore, the primary aim of this review was to compare post-operative function following AW and OW.…”