Arthroscopic Treatment of Septic Arthritis

Abstract

Purpose: Arthroscopy is superior to arthrotomy and needle aspiration in the treatment of septic arthritis (SA). The goal of this study was to evaluate patients treated arthroscopically due to SA of the knee, and to review relevant reports.
Patients and methods: Seven consecutive patients in whom SA of the knee had been treated with arthroscopic drainage and irrigation in the years 1998 and 1999 were evaluated. The indication for arthroscopic treatment was based on clinical findings, an elevated ESR and/or CRP, increased leukocyte count in the joint fluid, and no bone involvement on plain x-rays. Spinal and general anesthesia were used in two patients each, and local anesthesia in three. Arthroscopic management (amount of lavage, debridement, synovectomy etc.) was performed according to intraoperative findings. Postoperative irrigation system was used in four cases. All patients received rehabilitation in the early postoperative period.
Results: An average of 7 liters (range, 3 to 12 L) of sterile saline was used during arthroscopic lavage. Partial synovectomy was performed in one patient because of significant synovial hypertrophy. Mean duration of surgical procedure was 24 minutes (range, 15 to 40 minutes). Symptoms and clinical findings of all patients resolved significantly in the early postoperative period. Five patients had good clinical outcome. However, results were not satisfying in two patients whose general status were bad because of co-morbidities and difficulties in adaptation to the rehabilitation program.
Discussion: Although most patients had prodromal symptoms lasting for more than three days, the arthroscopic procedure was accomplished without any difficulties. This fact indicates that arthroscopy may be performed successfully even in delayed phases of SA unless the infection spreads extra-articularly. We conclude that arthroscopy should be the treatment of choice in SA, since it is a semi-invasive procedure which takes little time to perform. It is an effective method of drainage that can be achieved with local anesthesia even in patients whom are in poor condition.