Paper of the Week: Arthroscopic Versus Open Treatment for Acute Septic Arthritis of the Knee in Children

Paper of the Week: Arthroscopic Versus Open Treatment for Acute Septic Arthritis of the Knee in Children

ICM Philly August 18, 2020

Johns, Brenton MBBS; Loewenthal, Mark MBBS, MMed Sci, FRACP; Ho, Eric MBBS, FRACS, FRCS; Dewar, David MBBS, BMed Sci, FRACS

The Pediatric infectious disease journal 37.5 (2018): 413-418.
DOI: 10.1097/INF.0000000000001795; PMID: 28945678

Summary by Stephen DiMaria, BS

Children who develop septic arthritis can have devastating future consequences including joint stiffness, deformity, and osteonecrosis.1,2 Pediatric septic arthritis can be managed with repeat aspiration of the joint, but surgical irrigation is more commonly used as it allows for debridement and joint visualization, which cannot be achieved by needle aspiration alone, and surgical irrigation has a lower failure rate than needle aspiration.3,4 Two methods of surgical irrigation exist: open and arthroscopic. The goal of this study was to compare short and long-term outcomes of arthroscopic versus open surgical irrigation for the treatment of pediatric acute septic knee arthritis.

In the study, the investigators performed a retrospective review of pediatric patients with acute septic knee arthritis treated by arthroscopic and open methods from 1996-2015. The authors compared short and long-term outcomes of the two surgical irrigation methods by reviewing the clinical presentations, operative details, microorganisms, laboratory results, knee radiologic findings and antibiotics administered. Long-term outcomes were evaluated at a mean of 6.9 years. Eleven patients received arthroscopic irrigation and 13 received open irrigation. Five patients in the open group required a second irrigation whereas none in the arthroscopic group required irrigation (p = 0.041).  Time to achieve range of motion of the knee occurred earlier in the arthroscopic group (5 days vs. 10.6 days for open, p = 0.023), as did time to weight-bearing (arthroscopic 2.7 days vs. open 10.3 days, p = 0.008). No infections recurred and no differences were observed in long-term outcomes, which included the Knee Injury and Osteoarthritis Outcome Scores for children, Lysholm’s scores, range of motion, leg length, gait and radiologic findings.

In summary, the authors found arthroscopic irrigation for the treatment of pediatric acute septic knee arthritis is associated with fewer repeat irrigations and earlier knee ranging and weight-bearing compared to open surgical irrigation. However, at long-term follow up, there were no significant differences between groups. Limitations of the study include the fact that patients were not randomized into treatment groups and that most of the data were collected retrospectively.

References:

  1. Glorion, C. et al. [Acute infectious arthritis of the knee in children. Prognosis and therapeutic discussion apropos of 51 cases with an average follow-up of 5 years]. Revue De Chir Orthopédique Et Réparatrice De L’appareil Moteur 79, 650–60 (1993).
  2. Howard, J. B., Highgenboten, C. L. & Nelson, J. D. Residual effects of septic arthritis in infancy and childhood. Jama 236, 932–5 (1976).
  3. Agarwal, A. & Aggarwal, A. N. Bone and Joint Infections in Children: Septic Arthritis. Indian J Pediatr 83, 825–33 (2015).
  4. Agout, C., Lakhal, W., Fournier, J., Bodman, C. de & Bonnard, C. Arthroscopic treatment of septic arthritis of the knee in children. Orthop Traumatology Surg Res Otsr 101, S333-6 (2015).
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