Arthrotomy vs. Arthroscopy for the Treatment of the Septic Knee: A Systematic Review

Background:
Acute native septic arthritis of the knee is a surgical emergency with delayed recognition and treatment being associated with articular cartilage destruction and potential sepsis.

Purpose:
To systematically review the published literature to evaluate and compare arthrotomy and arthroscopic irrigation in septic arthritis management.

Methods:
PubMed, EMBASE, Web of Science, and the Cochrane Database of Systematic Reviews were systematically searched to identify publications relevant to this review. Studies included in this systematic review compared between the two common surgical methods to treat knee septic arthritis.

Results:
Twelve retrospective cohorts and one Randomized Controlled Trial were included. Follow-up period varied between 30 days and several years. Male predominance was noticed at over 60%. Negative cultures were reported at around 50%. Intra-operative cultures yielded more positive cultures than simple joint aspiration reaching over 75% when reported. Staph. Aureus predominates the positive cultures. Both methods showed favourable results in management of septic arthritis. Several studies showed slightly improved immediate post-operative pain. Two study reported long term benefit in terms of range of motion and function in the arthroscopic group. One study reported that delay in operative treatment had a recognizable effect on the outcomes. Most studies did not find statistically significant differences in terms of complications and mortality. Readmission and reoperation were reported in most studies, without apparent difference between the two modalities. One study evaluated cost-effectiveness and reported better scores for open management with slightly shorter length of stay reported in six studies, one of which showed significance.

Conclusions:
Both arthrotomy and arthroscopy benefit patients with septic arthritis of the knee.

Apart from high-grade arthritis involving the subchondral bone in which arthrotomy has an advantage over arthroscopy, only minor short-term differences were identified, leading us to encourage surgeons to choose the modality they are more capable to perform.