McKenna Daniel P, Miller Peggy, McAleese Timothy, Cleary May
Department of Trauma and Orthopaedic Surgery University Hospital Waterford Waterford Ireland.
Department of Orthopaedic Surgery University College Cork Cork Ireland.
J Exp Orthop. 2024 Jun 6;11(3):e12041. doi: 10.1002/jeo2.12041. eCollection 2024 Jul.
Septic arthritis of any joint is an orthopaedic emergency which requires prompt diagnosis and treatment. The knee is the commonest joint afflicted, and the primary objective of any treatment is complete source control. This commonly takes the form of antibiotic therapy and a washout of the infected joint by means of arthroscopy or arthrotomy. The primary aim of this review is to investigate if arthroscopic washout for native knee septic arthritis confers a lower risk of repeat procedure than arthrotomy.
A systematic review and meta-analysis was conducted of the MEDLINE, SCOPUS and the Cochrane Library data bases. The primary outcome of interest was requirement for repeat washout with all-cause complications, length of inpatient stay and mortality secondary outcomes.
A total of 17,140 subjects were included for analysis of the primary outcome, and the overall rate of repeat procedure was 14.6%. No statistical difference was found between arthroscopy and arthrotomy for repeat washout (risk ratio 0.86 [95% confidence interval, CI: 0.72-1.02], = 36%). Eligible studies found in favour of arthroscopy for all-cause complication rate (risk ratio 0.75 [95% CI: 0.6-0.93], = 84%) and length of stay in hospital (mean difference -1.98 days [95% CI: -3.43 to -0.53], = 84%). No statistical difference was found for the mortality rate (risk ratio 1.17 [95% CI: 0.52-2.63], = 57%).
Our analysis found arthroscopy and open arthrotomy to be equivocal for repeat surgical washout in native knee septic arthritis. All-cause complication rate and length of inpatient stay were favourable for arthroscopy with no difference noted between mortality rates.
Level III.
任何关节的化脓性关节炎都是骨科急症，需要及时诊断和治疗。膝关节是最常受累的关节，任何治疗的主要目标都是实现彻底的源头控制。这通常采取抗生素治疗以及通过关节镜检查或关节切开术对感染关节进行冲洗的形式。本综述的主要目的是研究对于原发性膝关节化脓性关节炎，关节镜冲洗与关节切开术相比，再次手术的风险是否更低。
对MEDLINE、SCOPUS和Cochrane图书馆数据库进行了系统评价和荟萃分析。感兴趣的主要结局是再次冲洗的需求以及全因并发症、住院时间和死亡率等次要结局。
共有17140名受试者纳入主要结局分析，再次手术的总体发生率为14.6%。关节镜检查和关节切开术在再次冲洗方面无统计学差异（风险比0.86[95%置信区间，CI：0.72 - 1.02]，P = 36%）。纳入的研究表明，在全因并发症发生率方面关节镜检查更具优势（风险比0.75[95%CI：0.6 - 0.93]，P = 84%），且住院时间方面也更具优势（平均差 - 1.98天[95%CI： - 3.43至 - 0.53]，P = 84%）。死亡率方面无统计学差异（风险比1.17[95%CI：0.52 - 2.63]，P = 57%）。
我们的分析发现，对于原发性膝关节化脓性关节炎的再次手术冲洗，关节镜检查和开放性关节切开术效果相当。全因并发症发生率和住院时间方面关节镜检查更具优势，死亡率方面无差异。
三级。
