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Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy 10/2016

28.05.2015 | Knee

Treatment of septic arthritis of the knee: a comparison between arthroscopy and arthrotomy

verfasst von: Christoph Böhler, Mirnic Dragana, Stephan Puchner, Reinhard Windhager, Johannes Holinka

Erschienen in: Knee Surgery, Sports Traumatology, Arthroscopy | Ausgabe 10/2016

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Abstract

Purpose

The aim of this study was to compare the efficacy of arthroscopy and arthrotomy in patients with septic monarthritis of the knee.

Methods

Seventy consecutive patients who underwent surgery because of a bacterial monarthritis were evaluated. Patients were either treated with arthroscopy or with arthrotomy. Our primary outcome was the early recurrence of infection (>3 months after surgery), which made a second surgical procedure necessary. Furthermore, the influence of potential confounders on treatment outcome was analysed.

Results

Of the 70 patients, 41 were treated arthroscopically and 29 with arthrotomy. Eight patients (11.4 %) had to undergo a second surgical procedure because of early re-infection. The rate was significantly higher in patients treated with arthrotomy (n = 6; 20.7 %) compared with those treated by arthroscopy (n = 2) (p = 0.041). Range of motion was significantly better in patients who underwent arthroscopy (p < 0.001). Male sex had negative influence on the treatment success (p = 0.03).

Conclusions

Patients with bacterial monarthritis of the knee who were treated with arthroscopy had a significantly lower re-infection rate and a better functional outcome than those treated with arthrotomy. As arthroscopy is the less invasive method, it should be considered the routine treatment, according to our data.

Level of evidence

Therapeutic study, Level III.
Literatur
1.
Zurück zum Zitat Aim F, Delambre J, Bauer T, Hardy P (2015) Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints. Orthop Traumatol Surg Res 101(1):61–64CrossRefPubMed Aim F, Delambre J, Bauer T, Hardy P (2015) Efficacy of arthroscopic treatment for resolving infection in septic arthritis of native joints. Orthop Traumatol Surg Res 101(1):61–64CrossRefPubMed
2.
Zurück zum Zitat Balabaud L, Gaudias J, Boeri C, Jenny JY, Kehr P (2007) Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc 15(4):387–392CrossRefPubMed Balabaud L, Gaudias J, Boeri C, Jenny JY, Kehr P (2007) Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc 15(4):387–392CrossRefPubMed
3.
Zurück zum Zitat Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMed Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383CrossRefPubMed
4.
Zurück zum Zitat Coakley G, Mathews C, Field M, Jones A, Kingsley G, Walker D, Phillips M, Bradish C, McLachlan A, Mohammed R, Weston V, British Society for Rheumatology Standards G, Audit Working G (2006) BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatol Oxf 45(8):1039–1041CrossRef Coakley G, Mathews C, Field M, Jones A, Kingsley G, Walker D, Phillips M, Bradish C, McLachlan A, Mohammed R, Weston V, British Society for Rheumatology Standards G, Audit Working G (2006) BSR & BHPR, BOA, RCGP and BSAC guidelines for management of the hot swollen joint in adults. Rheumatol Oxf 45(8):1039–1041CrossRef
5.
Zurück zum Zitat Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM, Bussiere JL, Sirot J, Sauvezie B (1993) Polyarticular septic arthritis. Med Baltim 72(5):296–310CrossRef Dubost JJ, Fis I, Denis P, Lopitaux R, Soubrier M, Ristori JM, Bussiere JL, Sirot J, Sauvezie B (1993) Polyarticular septic arthritis. Med Baltim 72(5):296–310CrossRef
6.
Zurück zum Zitat Dubost JJ, Soubrier M, De Champs C, Ristori JM, Bussiere JL, Sauvezie B (2002) No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis 61(3):267–269CrossRefPubMedPubMedCentral Dubost JJ, Soubrier M, De Champs C, Ristori JM, Bussiere JL, Sauvezie B (2002) No changes in the distribution of organisms responsible for septic arthritis over a 20 year period. Ann Rheum Dis 61(3):267–269CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Geirsson AJ, Statkevicius S, Vikingsson A (2008) Septic arthritis in Iceland 1990–2002: increasing incidence due to iatrogenic infections. Ann Rheum Dis 67(5):638–643CrossRefPubMed Geirsson AJ, Statkevicius S, Vikingsson A (2008) Septic arthritis in Iceland 1990–2002: increasing incidence due to iatrogenic infections. Ann Rheum Dis 67(5):638–643CrossRefPubMed
8.
Zurück zum Zitat Goldenberg DL, Brandt KD, Cohen AS, Cathcart ES (1975) Treatment of septic arthritis: comparison of needle aspiration and surgery as initial modes of joint drainage. Arthr Rheum 18(1):83–90CrossRef Goldenberg DL, Brandt KD, Cohen AS, Cathcart ES (1975) Treatment of septic arthritis: comparison of needle aspiration and surgery as initial modes of joint drainage. Arthr Rheum 18(1):83–90CrossRef
9.
Zurück zum Zitat Gupta MN, Sturrock RD, Field M (2001) A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatol Oxf 40(1):24–30CrossRef Gupta MN, Sturrock RD, Field M (2001) A prospective 2-year study of 75 patients with adult-onset septic arthritis. Rheumatol Oxf 40(1):24–30CrossRef
10.
Zurück zum Zitat Hinarejos P, Guirro P, Leal J, Montserrat F, Pelfort X, Sorli ML, Horcajada JP, Puig L (2013) The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees. J Bone Joint Surg Am 95(9):769–774CrossRefPubMed Hinarejos P, Guirro P, Leal J, Montserrat F, Pelfort X, Sorli ML, Horcajada JP, Puig L (2013) The use of erythromycin and colistin-loaded cement in total knee arthroplasty does not reduce the incidence of infection: a prospective randomized study in 3000 knees. J Bone Joint Surg Am 95(9):769–774CrossRefPubMed
11.
Zurück zum Zitat Hunter JG, Gross JM, Dahl JD, Amsdell SL, Gorczyca JT (2015) Risk factors for failure of a single surgical debridement in adults with acute septic arthritis. J Bone Joint Surg Am 97(7):558–564CrossRefPubMed Hunter JG, Gross JM, Dahl JD, Amsdell SL, Gorczyca JT (2015) Risk factors for failure of a single surgical debridement in adults with acute septic arthritis. J Bone Joint Surg Am 97(7):558–564CrossRefPubMed
12.
Zurück zum Zitat Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 56(8):470–475CrossRefPubMedPubMedCentral Kaandorp CJ, Dinant HJ, van de Laar MA, Moens HJ, Prins AP, Dijkmans BA (1997) Incidence and sources of native and prosthetic joint infection: a community based prospective survey. Ann Rheum Dis 56(8):470–475CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Koh IJ, Cho WS, Choi NY, Kim TK, Kleos Korea Research G (2014) Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res 472(1):316–326CrossRefPubMed Koh IJ, Cho WS, Choi NY, Kim TK, Kleos Korea Research G (2014) Causes, risk factors, and trends in failures after TKA in Korea over the past 5 years: a multicenter study. Clin Orthop Relat Res 472(1):316–326CrossRefPubMed
15.
Zurück zum Zitat Lane JG, Falahee MH, Wojtys EM, Hankin FM, Kaufer H (1990) Pyarthrosis of the knee. Treatment considerations. Clin Orthop Relat Res 252:198–204PubMed Lane JG, Falahee MH, Wojtys EM, Hankin FM, Kaufer H (1990) Pyarthrosis of the knee. Treatment considerations. Clin Orthop Relat Res 252:198–204PubMed
16.
Zurück zum Zitat Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M, Walker D, Coakley G (2007) Management of septic arthritis: a systematic review. Ann Rheum Dis 66(4):440–445PubMedPubMedCentral Mathews CJ, Kingsley G, Field M, Jones A, Weston VC, Phillips M, Walker D, Coakley G (2007) Management of septic arthritis: a systematic review. Ann Rheum Dis 66(4):440–445PubMedPubMedCentral
17.
Zurück zum Zitat Mathews CJ, Weston VC, Jones A, Field M, Coakley G (2010) Bacterial septic arthritis in adults. Lancet 375(9717):846–855CrossRefPubMed Mathews CJ, Weston VC, Jones A, Field M, Coakley G (2010) Bacterial septic arthritis in adults. Lancet 375(9717):846–855CrossRefPubMed
18.
Zurück zum Zitat Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117(3):423–428CrossRefPubMedPubMedCentral Morgan DS, Fisher D, Merianos A, Currie BJ (1996) An 18 year clinical review of septic arthritis from tropical Australia. Epidemiol Infect 117(3):423–428CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757PubMed Outerbridge RE (1961) The etiology of chondromalacia patellae. J Bone Joint Surg Br 43-B:752–757PubMed
20.
Zurück zum Zitat Rasouli MR, Restrepo C, Maltenfort MG, Purtill JJ, Parvizi J (2014) Risk factors for surgical site infection following total joint arthroplasty. J Bone Joint Surg Am 96(18):e158CrossRefPubMed Rasouli MR, Restrepo C, Maltenfort MG, Purtill JJ, Parvizi J (2014) Risk factors for surgical site infection following total joint arthroplasty. J Bone Joint Surg Am 96(18):e158CrossRefPubMed
21.
Zurück zum Zitat Richard JC, Vilain R (1982) Acute septic arthritis of the fingers. A clinical study of 87 cases. Ann Chir Main 1(3):214–220CrossRefPubMed Richard JC, Vilain R (1982) Acute septic arthritis of the fingers. A clinical study of 87 cases. Ann Chir Main 1(3):214–220CrossRefPubMed
22.
Zurück zum Zitat Sammer DM, Shin AY (2010) Comparison of arthroscopic and open treatment of septic arthritis of the wrist. Surgical technique. J Bone Joint Surg Am 92(Suppl 1 Pt 1):107–113PubMed Sammer DM, Shin AY (2010) Comparison of arthroscopic and open treatment of septic arthritis of the wrist. Surgical technique. J Bone Joint Surg Am 92(Suppl 1 Pt 1):107–113PubMed
23.
Zurück zum Zitat Shulman G, Waugh TR (1988) Acute bacterial arthritis in the adult. Orthop Rev 17(10):955–960PubMed Shulman G, Waugh TR (1988) Acute bacterial arthritis in the adult. Orthop Rev 17(10):955–960PubMed
24.
25.
Zurück zum Zitat Stutz G, Kuster MS, Kleinstuck F, Gachter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8(5):270–274CrossRefPubMed Stutz G, Kuster MS, Kleinstuck F, Gachter A (2000) Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 8(5):270–274CrossRefPubMed
26.
Zurück zum Zitat Thiery JA (1989) Arthroscopic drainage in septic arthritides of the knee: a multicenter study. Arthroscopy 5(1):65–69CrossRefPubMed Thiery JA (1989) Arthroscopic drainage in septic arthritides of the knee: a multicenter study. Arthroscopy 5(1):65–69CrossRefPubMed
27.
Zurück zum Zitat Vispo Seara JL, Barthel T, Schmitz H, Eulert J (2002) Arthroscopic treatment of septic joints: prognostic factors. Arch Orthop Trauma Surg 122(4):204–211CrossRefPubMed Vispo Seara JL, Barthel T, Schmitz H, Eulert J (2002) Arthroscopic treatment of septic joints: prognostic factors. Arch Orthop Trauma Surg 122(4):204–211CrossRefPubMed
28.
Zurück zum Zitat Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M (1999) Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis 58(4):214–219CrossRefPubMedPubMedCentral Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M (1999) Clinical features and outcome of septic arthritis in a single UK Health District 1982–1991. Ann Rheum Dis 58(4):214–219CrossRefPubMedPubMedCentral
29.
Zurück zum Zitat Wirtz DC, Marth M, Miltner O, Schneider U, Zilkens KW (2001) Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy. Int Orthop 25(4):239–241CrossRefPubMedPubMedCentral Wirtz DC, Marth M, Miltner O, Schneider U, Zilkens KW (2001) Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy. Int Orthop 25(4):239–241CrossRefPubMedPubMedCentral
Metadaten
Titel
Treatment of septic arthritis of the knee: a comparison between arthroscopy and arthrotomy
verfasst von
Christoph Böhler
Mirnic Dragana
Stephan Puchner
Reinhard Windhager
Johannes Holinka
Publikationsdatum
28.05.2015
Verlag
Springer Berlin Heidelberg
Erschienen in
Knee Surgery, Sports Traumatology, Arthroscopy / Ausgabe 10/2016
Print ISSN: 0942-2056
Elektronische ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-015-3659-8

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