Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK.
Bedfordshire Hospitals NHS Foundation Trust, Bedford, UK.
Syst Rev. 2024 Apr 12;13(1):106. doi: 10.1186/s13643-024-02508-1.
Septic arthritis (SA) of the native knee joint is associated with significant morbidity. This review compared post-operative functional outcomes (patient-reported outcome measures (PROMs) and range of movement (ROM)) following arthroscopic washout (AW) and open washout (OW) amongst adult patients with SA of the native knee. The need for further operative intervention was also considered.
Electronic databases of PubMed, MEDLINE, Embase, Cochrane, Web of Science and Scopus were searched between 16 February 2023 and 18 March 2023. Randomised controlled trials (RCTs) and comparative observational analytic studies comparing function (reflected in PROMs or ROM) at latest follow-up following AW and OW were included. A narrative summary was provided concerning post-operative PROMs. Pooled estimates for mean ROM and re-operation rates were conducted using the random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias assessment tool-2 for RCTs and the Risk of Bias in Non-Randomized Studies of Interventions tool for observational analytic studies.
Of 2580 retrieved citations, 7 articles (1 RCT and 6 cohort studies) met the inclusion criteria. Of these, five had some concerns/moderate risk of bias, and two had serious risk. There was a slight tendency for superior mean PROMs following AW compared with OW, but due to small effect sizes, this was unlikely clinically relevant. Additionally, the use of four different PROMs scales made direct comparisons impossible. AW was associated with superior ROM (mean difference 20.18° (95% CI 14.35, 26.02; p < 0.00001)), whilst there was a tendency for lower re-operation requirements following AW (OR 0.64, 95% CI 0.26, 1.57, p = 0.44).
AW was associated with equivalent to superior post-operative function and lower requirement for further intervention compared with OW. Results need to be interpreted cautiously, taking into consideration the methodological and clinical heterogeneity of the included studies.
PROSPERO 2022, CRD42022364062.
原发性膝关节化脓性关节炎与显著的发病率有关。本综述比较了关节镜灌洗（AW）和开放式灌洗（OW）治疗原发性膝关节化脓性关节炎成年患者的术后功能结局（患者报告的结局测量（PROMs）和活动范围（ROM））。还考虑了进一步手术干预的需求。
于 2023 年 2 月 16 日至 2023 年 3 月 18 日在 PubMed、MEDLINE、Embase、Cochrane、Web of Science 和 Scopus 电子数据库中检索随机对照试验（RCT）和比较观察性分析研究，这些研究比较了 AW 和 OW 后随访时的功能（反映在 PROMs 或 ROM 中）。提供了关于术后 PROMs 的叙述性总结。使用随机效应模型对平均 ROM 和再手术率的汇总估计进行了计算。使用 Cochrane 偏倚风险评估工具-2 评估 RCT 的偏倚风险，使用干预非随机研究的偏倚风险工具评估观察性分析研究的偏倚风险。
在 2580 篇检索文献中，有 7 篇文章（1 篇 RCT 和 6 篇队列研究）符合纳入标准。其中，有 5 项研究存在一定的偏倚/中度风险，有 2 项研究存在严重风险。AW 后平均 PROM 稍好于 OW，但由于效应量较小，这可能在临床上并不重要。此外，使用了四种不同的 PROM 量表使得直接比较变得不可能。AW 与更好的 ROM 相关（平均差异 20.18°（95%CI 14.35，26.02；p<0.00001）），而 AW 后再手术的需求有降低的趋势（OR 0.64，95%CI 0.26，1.57，p=0.44）。
与 OW 相比，AW 术后功能相当或更好，进一步干预的需求较低。考虑到纳入研究的方法学和临床异质性，结果需要谨慎解释。
PROSPERO 2022，CRD42022364062。
