From the Guidelines
Arthroscopic irrigation and debridement is generally preferred for early, uncomplicated septic knee infections due to its minimally invasive nature, reduced morbidity, and faster recovery times, while open irrigation and debridement is more suitable for complex cases with significant purulence or hardware involvement. When considering the treatment of septic knee arthritis, it is essential to weigh the benefits and drawbacks of each surgical approach. The choice between open and arthroscopic irrigation and debridement depends on specific clinical factors, including infection severity, patient comorbidities, and surgeon expertise 1.
Key Considerations
- Infection severity: Complex cases with significant purulence, compartmentalization, or advanced infection may require open irrigation and debridement.
- Patient comorbidities: Presence of hardware, compromised immune system, or other underlying health conditions may influence the choice of surgical approach.
- Surgeon expertise: The surgeon's experience and proficiency with each technique should be taken into account when deciding between open and arthroscopic irrigation and debridement.
Treatment Approach
Regardless of the chosen surgical approach, thorough debridement of all infected tissue, copious irrigation (typically with 9-12 liters of normal saline), and appropriate antibiotic therapy are crucial components of treatment 1. Postoperative management includes joint immobilization, physical therapy, and a tailored course of antibiotics (initially intravenous, then oral) based on culture results. The ultimate goal is to eradicate infection while preserving joint function, with the specific surgical approach tailored to achieve optimal outcomes for each patient.
Antibiotic Therapy
Recent studies suggest that shorter courses of antibiotic therapy may be effective in certain cases, with a 6-week course potentially being adequate for some patients 1. However, the optimal duration of antibiotic therapy remains unclear and should be individualized based on the specific clinical scenario and patient factors.
From the Research
Comparison of Open Irrigation and Debridement versus Arthroscopic Irrigation and Debridement
- The study 2 compared the 30-day complications and adverse outcomes between arthroscopic irrigation and debridement (n = 464) and open irrigation and debridement (n = 231) for septic arthritis of the knee, and found that arthroscopic irrigation and debridement was associated with lower rates of bleeding requiring transfusion, lower rates of adverse events, and higher home discharge rates.
- Another study 3 compared the 90-day postoperative complications between arthroscopic and open irrigation and debridement for septic arthritis of the native knee, and found that arthroscopic irrigation and debridement had similar rates of reoperation and most postoperative outcomes, but lower rates of readmission, postoperative anemia, and blood transfusion.
- A study 4 compared arthroscopic debridement alone versus combined with continuous closed irrigation-suction system for septic knee arthritis, and found that the combined treatment had fewer reoperations and a shorter hospital stay in stage II and III infections.
- The study 5 found that methicillin-resistant Staphylococcus aureus (MRSA) infection was a risk factor for unplanned return to the operating room after arthroscopic treatment of septic arthritis, and suggested that open surgical treatment may be considered in the setting of MRSA infections.
- Another study 6 found that early arthroscopic decompression and debridement with continuous suction irrigation can eradicate septic arthritis, and resulted in satisfactory functional outcomes and shorter duration of intravenous antibiotics and hospital stay.
Key Findings
- Arthroscopic irrigation and debridement may be associated with lower rates of complications and adverse events compared to open irrigation and debridement for septic arthritis of the knee 2, 3.
- The choice of treatment may depend on various factors, including the stage of infection, the presence of MRSA, and the patient's overall health status 4, 5.
- Early intervention and aggressive treatment are crucial for successful outcomes in septic arthritis 6.
Complications and Adverse Events
- Bleeding requiring transfusion was significantly lower in the arthroscopic group compared to the open group 2.
- Readmission, postoperative anemia, and blood transfusion were lower in the arthroscopic group compared to the open group 3.
- MRSA infection was a risk factor for unplanned return to the operating room after arthroscopic treatment 5.