Open Access, Peer-reviewed
pISSN 1226-2102
eISSN 2005-8918
    J Korean Orthop Assoc. 2016 Aug;51(4):308-314. Korean.
    Published online Aug 11, 2016.
    https://doi.org/10.4055/jkoa.2016.51.4.308
    Copyright © 2016 by The Korean Orthopaedic Association
    Original Article

    The Efficacy of Arthroscopic Debridement with Continuous Irrigation in Failed Arthroscopic Debridement for Septic Arthritis of the Knee

    Young Dae Jeon, M.D., Jang Yong Moon, M.D., Jung Hwan Son, M.D., Jong Min Kim, M.D. and Young Choi, M.D.
      • Department of Orthopaedic Surgery, Kosin University Gospel Hospital, Busan, Korea.
    • Correspondence to: Young Choi, M.D. Department of Orthopaedic Surgery, Kosin University Gospel Hospital, 262 Gamcheon-ro, Seo-gu, Busan 49267, Korea. TEL: +82-51-990-6467, FAX: +82-51-243-0181, Email: yuzo0n@naver.com
    Received June 16, 2015; Revised December 04, 2015; Accepted February 12, 2016.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Purpose

    The purpose of this study is to evaluate the efficacy of arthroscopic debridement with continuous irrigation in patients with septic arthritis of the knee after failed primary arthroscopic treatment.

    Materials and Methods

    Among 69 patients undergoing arthroscopic debridement for septic arthritis of the knee from March 2008 to March 2013, 14 patients (5 male, 9 female; mean age, 68.9±11.3 years) with failed arthroscopic debridement for septic arthritis of the knee were reviewed retrospectively (mean follow-up period, 49.2±23.2 months). All 14 patients underwent re-do of the arthroscopic debridement, then continuous irrigation. Continuous irrigation following arthroscopic debridement was maintained for a mean 8.4±2.5 days. For clinical evaluation, Lysholm knee score and visual analogue scale (VAS) were used at 1 month, 3 months, and 12 months after surgery. During the entire follow-up period, recurrence of infection and operation-related complication were also assessed.

    Results

    Symptom improvement was observed in 12 cases (85.7%) of the 14 cases. Lysholm knee score was improved from 36.1±7.9 to 84.2±9.2 at 12 months after surgery (p<0.05). VAS was improved from 8.9±1.3 to 2.1±1.2 at 12 months after surgery (p<0.05). Synovial fluid cultures yielded positive findings in 9 of the 14 cases with the same bacteria in primary surgery. During the follow-up period, septic arthritis relapsed in 2 of the 5 cases with negative finding of cultures. After reoperation was performed in those 2 cases, no recurrence was observed to final follow-up. There was no complication related operation in any cases.

    Conclusion

    Arthroscopic debridement combined with continuous irrigation is a safe and effective procedure for failed arthroscopic debridement for septic arthritis of the knee.

    Keywords
    knee; septic arthritis; arthroscopy; continuous irrigation

    Figures

    Figure 1
    Establishment of a continuous irrigation system of the knee joint. (A) Continuous irrigation system after arthroscopic debridement for septic arthritis of the left knee. (B) Positioning of the drains in the knee.

    Figure 2
    Changing pattern of C-reactive protein (CRP) in the patients with failed septic arthritis of the knee. Preop, preoperative; Postop, postoperative; DM, diabetes mellitus; RA, rheumatoid arthritis.

    Tables

    Table 1
    Septic Arthritis of the Knee Stage according to the Gächter Criteria16)

    Table 2
    Characteristics of the Patients with Failed Septic Arthritis of the Knee

    Table 3
    Change of the CRP among the Patients with Failed Septic Arthritis of the Knee

    Notes

    CONFLICTS OF INTEREST:The authors have nothing to disclose.

    References

      1. Broy SB, Schmid FR. A comparison of medical drainage (needle aspiration) and surgical drainage (arthrotomy or arthroscopy) in the initial treatment of infected joints. Clin Rheum Dis 1986;12:501–522.
      1. Jarrett MP, Grossman L, Sadler AH, Grayzel AI. The role of arthroscopy in the treatment of septic arthritis. Arthritis Rheum 1981;24:737–739.
      1. Stutz G, Kuster MS, Kleinstück F, Gächter A. Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 2000;8:270–274.
      1. Armstrong RW, Bolding F, Joseph R. Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 1992;8:213–223.
      1. Montgomery SC, Campbell J. Septic arthritis following arthroscopy and intra-articular steroids. J Bone Joint Surg Br 1989;71:540.
      1. Smith JW, Piercy EA. Infectious arthritis. Clin Infect Dis 1995;20:225–230.
        quiz 231.
      1. Vincent GM, Amirault JD. Septic arthritis in the elderly. Clin Orthop Relat Res 1990;251:241–245.
      1. Goldenberg DL. Septic arthritis. Lancet 1998;351:197–202.
      1. Tsumura H, Ikeda S, Torisu T. Debridement and continuous irrigation for the treatment of pyogenic arthritis caused by the use of intra-articular injection in the osteoarthritic knee: indications and outcomes. J Orthop Surg (Hong Kong) 2005;13:52–57.
      1. Kuo CL, Chang JH, Wu CC, Shen PH, Wang CC, Lin LC, et al. Treatment of septic knee arthritis: comparison of arthroscopic debridement alone or combined with continuous closed irrigation-suction system. J Trauma 2011;71:454–459.
      1. Shukla A, Beniwal SK, Sinha S. Outcome of arthroscopic drainage and debridement with continuous suction irrigation technique in acute septic arthritis. . J Clin Orthop Trauma 2014;5:1–5.
      1. Baek SH, Kim SS. Arthroscopic management for pyogenic arthritis with positive culture in the knee joint. J Korean Arthrosc Soc 2012;16:167–174.
      1. Lee DC, Shon OJ, Kong BS. Arthroscopic treatment of septic knee arthritis in old aged group: prognostic factor. J Korean Arthrosc Soc 2010;14:114–119.
      1. Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am 2006;88:869–882.
      1. Birmingham P, Helm JM, Manner PA, Tuan RS. Simulated joint infection assessment by rapid detection of live bacteria with real-time reverse transcription polymerase chain reaction. J Bone Joint Surg Am 2008;90:602–608.
      1. The Korean Orthopaedic Association. Orthopaedics. 7th ed. Seoul: Choishineuihaksa; 2013. pp. 355.
      1. Gaechter A. Arthroscopic lavage for joint infections. Orthop Traumatol 1993;2:104–106.
      1. Ivey M, Clark R. Arthroscopic debridement of the knee for septic arthritis. Clin Orthop Relat Res 1985;199:201–206.
      1. Thiery JA. Arthroscopic drainage in septic arthritides of the knee: a multicenter study. Arthroscopy 1989;5:65–69.
      1. Jeon IH, Choi CH, Seo JS, Seo KJ, Ko SH, Park JY. Arthroscopic management of septic arthritis of the shoulder joint. J Bone Joint Surg Am 2006;88:1802–1806.
      1. Kim SJ, Choi NH, Ko SH, Linton JA, Park HW. Arthroscopic treatment of septic arthritis of the hip. Clin Orthop Relat Res 2003;407:211–214.
      1. Ladner B, Nester K, Cascio B. Abdominal fluid extravasation during hip arthroscopy. Arthroscopy 2010;26:131–135.
      1. Parisien JS, Shaffer B. Arthroscopic management of pyarthrosis. Clin Orthop Relat Res 1992;275:243–247.
      1. Nelson JD. Antibiotic concentrations in septic joint effusions. N Engl J Med 1971;284:349–353.
      1. Jackson RW, Parsons CJ. Distension-irrigation treatment of major joint sepsis. Clin Orthop Relat Res 1973;96:160–164.
      1. Gainor BJ. Instillation of continuous tube irrigation in the septic knee at arthroscopy. A technique. Clin Orthop Relat Res 1984;183:96–98.
      1. D'Angelo GL, Ogilvie-Harris DJ. Septic arthritis following arthroscopy, with cost/benefit analysis of antibiotic prophylaxis. Arthroscopy 1988;4:10–14.
      1. Chung WK, Slater GL, Bates EH. Treatment of septic arthritis of the hip by arthroscopic lavage. J Pediatr Orthop 1993;13:444–446.
      1. Argen RJ, Wilson CH Jr, Wood P. Suppurative arthritis. Clinical features of 42 cases. Arch Intern Med 1966;117:661–666.
      1. Frimodt-Møller N, Riegels-Nielsen P. Antibiotic penetration into the infected knee. A rabbit experiment. Acta Orthop Scand 1987;58:256–259.
    Cited by
    Crossref 6
    Google Scholar 
    MeSH Terms
    Arthritis, Infectious*
    Arthroscopy
    Bacteria
    Debridement*
    Female
    Follow-Up Studies
    Humans
    Knee*
    Lysholm Knee Score
    Male
    Recurrence
    Reoperation
    Retrospective Studies
    Synovial Fluid
    Metrics
    Share
    Figures
    slide
    slide

    1 / 2

    Tables
    slide
    slide
    slide

    1 / 3

    PERMALINK