Abstract
Introduction: Knee joint infection still cannot be completely prevented after operation, especially arthroscopy. Arthroscopic rinse under systemic antibiotic treatment is the recommended therapy. The concept of “repeated arthroscopic revisions” is presented in this report.
Method: After diagnosing post-arthroscopic knee joint infection in the 2nd or 3rd stage according to Gächter, arthroscopy was performed in the infected knee joint repeatedly at defined intervals until the clinical, the laboratory chemical, and arthroscopic signs of infection had faded and it was not possible to detect the germs microbiologically.
Results: In the 13 patients who had undergone prior arthroscopy for different indications, infection eased after 3-8 (average 4.8) revisions, whereby, open revisions were unnecessary. There was proof of germs in 61.5 % of the cases, mainly of Staphylococcus aureus. CRP proved to be the essential laboratory parameter for observing the development, whereas the WBC count proved to be less reliable. After 6-18 (average 12.5) months, there were no occurrences of infection relapses. The follow-up results were similarly good in the Lysholm as well as the IKDC score.
Conclusion: Although medical reports present us with high percentages of stage-dependent cures after only one arthroscopic revision, we recommend this concept of “repeated arthroscopic revisions” as a reliable, relapse-free method of healing.
Key words
Arthroscopy - synovectomy - post-operative knee joint infection - spectrum of germs
References
-
1
D'Angelo G L, Ogilvie-Harris D J.
Septic arthritis following arthroscopy, with cost/benefit analysis of antibiotic prophylaxis.
Arthroscopy.
1988;
4
10-14
-
2
DeLee J C.
Complications of arthroscopy and arthroscopic surgery: results of a national survey.
J Arthroscopic Rel Surg.
1985;
1
214-220
-
3
Dittrich V, Attmannspacher W, Stedtfeld H-W.
Gelenkinfektionen. Klassifikation, Diagnostik und Therapie.
Chirurg.
2002;
73
959-967
-
4
Esenwein S A, Kollig E, Kutscha-Lissberg F, Klapperich T, Muhr G.
Letale Weichteilinfektion nach Arthroskopie des Kniegelenkes. Ein diagnostisches oder therapeutisches Problem?.
Unfallchirurg.
2000;
103
795-801
-
5
Frimodt-Moller N, Riegels-Nielsen P.
Antibiotic penetration into the infected knee. A rabbit experiment.
Acta Orthop Scand.
1987;
58
256-259
-
6
Gächter A.
Der Gelenkinfekt.
Inform.
Arzt1985;
6
35-43
-
7
Gächter A.
Gelenkinfekt. Arthroskopische Spülbehandlung - Hints und Tricks.
Arthroskopie.
1994;
7
98-101
-
8
Ivey M, Clark R.
Arthroscopic debridement of the knee for septic arthritis.
Clin Orthop.
1985;
199
201-206
-
9
Jerosch J, Prymka M.
Arthroskopische Therapie der septischen Arthritis. Operative Technik und Ergebnisse.
Unfallchirurg.
1998;
101
454-460
-
10
Kelly P J, Martin W J, Coventry M B.
Bacterial arthritis in the adult.
J Bone Joint Surg [Am].
1970;
52
1595-1598
-
11
Kohn D.
Unsuccessful arthroscopic treatment of pyarthrosis following anterior cruciate ligament reconstruction.
Arthroscopy.
1988;
4
287-289
-
12
Muhr G, Giebel G, Tscherne H.
Synovektomie bei der eitrigen Kniegelenksentzündung.
Orthopäde.
1983;
19
229-234
-
13
Neumann K, Muhr G.
Der Kniegelenkinfekt - eine arthroskopische Herausforderung?.
Orthopäde.
1990;
19
111-116
-
14
Singer J, Böhmer G, Wittek F, Kortmann H R.
Die Behandlung des akuten und chronischen Kniegelenkempyems.
Z Orthop.
2002;
140 (Suppl 1)
126
-
15
Smith M J.
Arthroscopic treatment of the septic knee.
Arthroscopy.
1986;
2
30-34
-
16
Stutz G, Gächter A.
Diagnostik und stadiengerechte Therapie von Gelenkinfekten.
Unfallchirurg.
2001;
104
682-686
-
17
Ward J, Cohen A S, Bauer W.
The diagnosis and therapy of acute suppurative arthritis.
Arthritis Rheum.
1960;
3
522-529
-
18
Williams R J, Laurencin C T, Warren R F, Speciale A C, Brause B D, O'Brien S.
Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Diagnosis and management.
Am J Sports Med.
1997;
25
261-267
-
19
Witt S N, Betz A, Hierner R, Schweiberer L.
Arthroskopische Behandlung von Gelenkinfekten mit Hilfe der Jet-Lavage (Pulsed irrigation).
Arthroskopie.
1992;
5
140-142
Dr. med. Ralf Kraus
Klinik und Poliklinik für Unfallchirurgie · Justus-Liebig-Universität
Rudolf-Buchheim-Straße 7
35385 Gießen
Germany
Phone: +49/6 41-9 94-42 00
Fax: +49/6 41-9 94-46 09
Email: vimira@t-online.de
