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J Knee Surg 2023; 36(09): 949-956
DOI: 10.1055/s-0042-1747948
Original Article

Comparison of Arthroscopy versus Open Arthrotomy for Treatment of Septic Arthritis of the Native Knee: Analysis of 90-Day Postoperative Complications

Authors

  • Alexander Dobek 

    1   Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

  • Jordan Cohen

    2   Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania

  • Pradip Ramamurti

    3   Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia

  • Alex Gu 

    1   Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

  • Gregory J. Golladay

    4   Department of Orthopaedic Surgery, Virginia Commonwealth University Health, Richmond, Virginia

  • Teresa Doerre

    1   Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia

  • Savyasachi Thakkar

    5   Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Columbia, Maryland
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Abstract

Septic arthritis is an orthopaedic emergency, often necessitating surgical debridement, and the knee joint is most frequently affected. Arthroscopic and open irrigation and debridement (I&D) are the two commonest surgical treatments for septic arthritis of the native knee. Several studies have compared outcomes of open and arthroscopic management without coming to a clear conclusion which yields superior outcomes. The purpose of this study was to compare the results of these two surgical techniques to treat septic arthritis of the native knee using a large nationwide database. Patients who underwent arthroscopic or open I&D as treatment for knee septic arthritis from 2010 to 2019 were identified using a national insurance database. The primary outcome was the 90-day reoperation rate. Secondary outcomes included surgical site infection, readmission, and other postoperative complications. A total of 1,139 patients were identified, 618 of whom (54%) underwent open treatment and 521 (46%) underwent arthroscopic treatment. The two groups did not differ significantly by age, gender, or most comorbidities. There was no significant difference in 90-day reoperation rate between the groups (15.0.% open and 18.0% arthroscopic, p = 0.174). Patients who underwent open treatment had increased odds of readmission to the hospital (odds ratio [OR] = 1.46 [1.14–1.86]; p = 0.003), postoperative anemia (OR = 1.71 [1.08–2.75]; p = 0.025), and blood transfusion (OR = 1.76 [1.04–3.06]; p = 0.040) compared with those who underwent arthroscopic surgery. Using administrative claims data, we found that arthroscopic and open I&D have similar rates of reoperation and most 90-day postoperative outcomes. Lower rates of readmission, postoperative anemia, and blood transfusion were found with arthroscopic I&D, suggesting that arthroscopy may be preferable to open treatment in the management of septic arthritis of the native knee in cases in which other case- and surgeon-specific factors do not otherwise dictate the best treatment modality.

Keywords

infection - knee - acute

Note

The reaserch was done at the George Washington University School of Medicine and Health Sciences.




Publication History

Received: 29 November 2021

Accepted: 25 February 2022

Article published online:
05 May 2022

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