Department of Orthopaedic Surgery, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia.
Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
J Knee Surg. 2023 Jul;36(9):949-956. doi: 10.1055/s-0042-1747948. Epub 2022 May 5.
Septic arthritis is an orthopaedic emergency, often necessitating surgical debridement, and the knee joint is most frequently affected. Arthroscopic and open irrigation and debridement (I&D) are the two commonest surgical treatments for septic arthritis of the native knee. Several studies have compared outcomes of open and arthroscopic management without coming to a clear conclusion which yields superior outcomes. The purpose of this study was to compare the results of these two surgical techniques to treat septic arthritis of the native knee using a large nationwide database. Patients who underwent arthroscopic or open I&D as treatment for knee septic arthritis from 2010 to 2019 were identified using a national insurance database. The primary outcome was the 90-day reoperation rate. Secondary outcomes included surgical site infection, readmission, and other postoperative complications. A total of 1,139 patients were identified, 618 of whom (54%) underwent open treatment and 521 (46%) underwent arthroscopic treatment. The two groups did not differ significantly by age, gender, or most comorbidities. There was no significant difference in 90-day reoperation rate between the groups (15.0.% open and 18.0% arthroscopic, = 0.174). Patients who underwent open treatment had increased odds of readmission to the hospital (odds ratio [OR] = 1.46 [1.14-1.86]; = 0.003), postoperative anemia (OR = 1.71 [1.08-2.75]; = 0.025), and blood transfusion (OR = 1.76 [1.04-3.06]; = 0.040) compared with those who underwent arthroscopic surgery. Using administrative claims data, we found that arthroscopic and open I&D have similar rates of reoperation and most 90-day postoperative outcomes. Lower rates of readmission, postoperative anemia, and blood transfusion were found with arthroscopic I&D, suggesting that arthroscopy may be preferable to open treatment in the management of septic arthritis of the native knee in cases in which other case- and surgeon-specific factors do not otherwise dictate the best treatment modality.
化脓性关节炎是一种矫形急症，常需要手术清创，膝关节最常受累。关节镜和切开灌洗清创术（I&D）是治疗原发性膝关节化脓性关节炎最常见的两种手术方法。多项研究比较了切开与关节镜管理的结果，但没有得出哪种方法的结果更优。本研究旨在使用大型全国性数据库比较这两种手术技术治疗原发性膝关节化脓性关节炎的结果。使用国家保险数据库，确定 2010 年至 2019 年期间接受关节镜或切开 I&D 治疗膝关节化脓性关节炎的患者。主要结果是 90 天再手术率。次要结果包括手术部位感染、再入院和其他术后并发症。共确定了 1139 名患者，其中 618 名（54%）接受了开放性治疗，521 名（46%）接受了关节镜治疗。两组在年龄、性别或大多数合并症方面无显著差异。两组 90 天再手术率无显著差异（开放性 15.0%，关节镜 18.0%，=0.174）。接受开放性治疗的患者更有可能再次住院（优势比 [OR] = 1.46 [1.14-1.86]；=0.003）、术后贫血（OR = 1.71 [1.08-2.75]；=0.025）和输血（OR = 1.76 [1.04-3.06]；=0.040），与接受关节镜手术的患者相比。使用行政索赔数据，我们发现关节镜和切开 I&D 的再手术率和大多数 90 天术后结果相似。关节镜 I&D 术后再入院、贫血和输血的发生率较低，表明在其他病例和外科医生特定因素不决定最佳治疗方式的情况下，关节镜可能优于切开治疗原发性膝关节化脓性关节炎。
