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

Young Dae Jeon; Jang Yong Moon; Jung Hwan Son; Jong Min Kim; Young Choi

doi:10.4055/jkoa.2016.51.4.308

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Jeon, Moon, Son, Kim, and Choi: The Efficacy of Arthroscopic Debridement with Continuous Irrigation in Failed Arthroscopic Debridement for Septic Arthritis of the Knee

Original Article

Journal of the Korean Orthopaedic Association 2016; 51(4): 308-314.

Published online: 11 August 2016

DOI: https://doi.org/10.4055/jkoa.2016.51.4.308

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., 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, yuzo0n@naver.com

Received 16 June 2015 Revised 4 December 2015 Accepted 12 February 2016

(open-access):

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 and Tables

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.

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

^*Classification according to the standard of Gächter criteria. OP, operative; MRSA, methicillin-resistant Staphylococcus aureus; RA, rheumatoid arthritis; DM, diabetes mellitus.

Table 3

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

CRP, C-reactive protein; Preop, preoperative; Postop, postoperative.

Notes

^{CONFLICTS OF INTEREST} The authors have nothing to disclose.

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