Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA.
Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA.
Knee Surg Sports Traumatol Arthrosc. 2019 Oct;27(10):3304-3310. doi: 10.1007/s00167-018-5328-1. Epub 2019 Jan 2.
Septic arthritis of the knee is an orthopaedic emergency that is associated with marked morbidity and can potentially be life threatening. Surgical debridement can be performed either arthroscopically or via an arthrotomy. The aim of this study was to compare the 30-day complications and adverse outcomes between the two procedures.
Patients with a diagnosis of septic arthritis of the knee between 2011 and 2015 were identified using the ACS-NSQIP database. The study population included 695 patients, who had knee septic arthritis and underwent either an arthroscopic irrigation or debridement (I&D) (n = 464) or open irrigation and debridement (n = 231). Preoperative data included demographics, independent functional status, and comorbidities. Outcomes of interest included wound complications, infectious complications, cardiovascular events, hospital readmissions, and reoperations, or any of the previous adverse events.
Both cohorts were similar in most baseline characteristics. Bleeding requiring transfusion was significantly lower in the arthroscopic (n = 13; 3.6%) compared to the open procedure (n = 31; 13.4%; p = 0.0001). Home discharge was significantly higher in the arthroscopic irrigation and debridement group (n = 310; 67.5%) compared to the open group (n = 126; 55%; p = 0.0013). The overall incidence of adverse events was lower in the arthroscopic group (n = 158; 34%) compared to the open group (n = 112; 49%; p = 0.0002). There was no difference in rates of infectious complications, thromboembolic events, hospital readmission, reoperation, or mortality between the groups. Open irrigation and debridement was associated with higher risk of bleeding requiring transfusion (OR = 3.79; 95% CI: 2.02-7.13; p = 0.0001), higher risk of incidence of adverse events (OR = 1.46; 95% CI: 1.02-2.08; p = 0.039), and lower home discharge (OR = 3.79; 95% CI: 2.02-7.13; p = 0.0001) within 30 days after the procedure.
Arthroscopic irrigation and debridement demonstrated favourable short-term outcomes. Patients who underwent arthroscopic irrigation and debridement had lower rates of blood transfusions, lower rates of adverse events, and higher home discharge rates compared to open irrigation and debridement. This study is the largest analysis comparing arthroscopic vs. open irrigation and debridement in a national database sample. These findings conclude that arthroscopic debridement can be an alternative first-line option in managing septic arthritis.
III.
膝关节化脓性关节炎是一种骨科急症，会导致明显的发病率，且可能危及生命。可以通过关节镜或切开术进行清创术。本研究旨在比较两种手术 30 天内的并发症和不良结局。
使用 ACS-NSQIP 数据库确定 2011 年至 2015 年间膝关节化脓性关节炎的患者。研究人群包括 695 名接受关节镜灌洗或清创术（I&D）（n=464）或切开灌洗和清创术（n=231）的膝关节化脓性关节炎患者。术前数据包括人口统计学、独立功能状态和合并症。感兴趣的结果包括伤口并发症、感染性并发症、心血管事件、医院再入院和再次手术，或任何先前的不良事件。
两组在大多数基线特征上相似。需要输血的出血在关节镜（n=13；3.6%）组明显低于切开组（n=31；13.4%；p=0.0001）。关节镜灌洗和清创组（n=310；67.5%）的家庭出院率明显高于切开组（n=126；55%；p=0.0013）。关节镜组（n=158；34%）的不良事件总发生率明显低于切开组（n=112；49%；p=0.0002）。两组之间的感染性并发症、血栓栓塞事件、医院再入院、再次手术或死亡率无差异。切开灌洗和清创术与需要输血的出血风险增加相关（OR=3.79；95%CI：2.02-7.13；p=0.0001）、不良事件发生率增加相关（OR=1.46；95%CI：1.02-2.08；p=0.039），以及术后 30 天内家庭出院率降低相关（OR=3.79；95%CI：2.02-7.13；p=0.0001）。
关节镜灌洗和清创术显示出良好的短期结果。与切开灌洗和清创术相比，接受关节镜灌洗和清创术的患者输血率较低，不良事件发生率较低，家庭出院率较高。本研究是在全国数据库样本中比较关节镜与切开灌洗和清创术的最大分析。这些发现得出的结论是，关节镜清创术可以作为治疗化脓性关节炎的一线替代方案。
III 级。
