The eradication rate of infection in septic knee arthritis according to the Gächter Classification: a systematic review

Abstract

Introduction Knee septic arthritis rapidly damages the knee joint. Gächter described a classification of joint infections based on arthroscopic findings: an arthroscopic staging of the common disease has prognostic and therapeutic consequences. The aim of this systematic review was to analyze the application of the Gächter classification system to knee septic arthritis, evaluating prognostic and therapeutic implications of this classification. Materials and Methods A comprehensive electronic search of the literature was performed. The following search terms were used: (Arthroscopy* OR Arthrotom* OR Aspiration) AND Knee AND Septic AND Arthritis. The study reported the Gächter classification in septic knee arthritis and the eradication rate according to the type. The primary endpoint is the eradication rate of septic knee arthritis according to the Gächter sort. Secondary endpoints are surgical procedures according to Gächter classification and the rate of re-operations. Results Seven studies were included. The overall eradication rate of knee septic arthritis ranged from 90% to 100%: 95%-100% Gächter I; 97%-100% Gächter II; 67%-100% Gächter III; 50%-100% Gächter IV. Surgical treatments for knee septic arthritis included arthroscopic irrigation alone, articular irrigation, and debridement in knee arthroscopy or knee arthrotomy according to Gächter stage. However, 28% required re-operations for persistent infection: secondary procedures included further irrigation and debridement with the arthroscopic or arthrotomic approach. Conclusion Gächter classification showed a crucial prognostic role in predicting the outcome of surgical treatment of septic knee arthritis. Regardless of the procedure performed, a prompt operation and an accurate debridement of the synovial membrane are the most critical factors for eradicating infection and good clinical outcomes. Level of Evidence Level II, prognostic study

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.…”

“…In total, 17,140 index procedures for septic arthritis were identified. We note previous systematic reviews on this topic [ 2 , 11 , 28 , 38 ]; however, ours is the first to include Upfill‐Brown et al's [ 45 ] 14,365 subjects. In light of limited RCT on this subject, we believe ours to be the most definitive body of evidence to date for comparing arthroscopy to arthrotomy for septic knee arthritis.…”

“…Unfortunately of the included studies, only Bohler et al [ 6 ] published data on the severity of their subjects' disease. This limitation is important as some argue that with disease progression and corresponding bone involvement, only an open washout is appropriate [ 11 ]. However, it should be noted that Gachter grade is yet to be clinically validated for the management of septic arthritis [ 39 ].…”

Fracture-Related Infection in Bicolumnar Acetabular Fracture: A Case Report

“…Its major complication is dislocation due to its intrinsic instability; in our case reports, there was a persistent fracture of the acetabulum, which did not allow the implanting of a hip spacer without significant risk [ 30 , 31 ]. Thus, we treated the fracture-related infection with a two-stage revision, while septic arthritis of the hip with a one-stage revision [ 14 , 32 ]. In the second stage, we planned to perform the definitive osteosynthesis and implant of the total hip arthroplasty after the second aggressive debridement with irrigation [ 33 ].…”