Abstract
Despite the in-depth research into the treatment of acute septic arthritis of the knee, the morbidity and mortality are still significant.
The purpose of our study was to evaluate the efficacy of a treatment protocol including arthroscopic irrigation and debridement in resolving septic arthritis of the knee.
During a 6-year period, 18 patients presenting with septic arthritis of the knee were included in this study. In 10 cases, septic arthritis occurred after knee arthroscopy, in 2 after open trauma, in 2 more after joint aspiration or injection; there were 2 hematogenous infections and 2 following contiguous spread from an adjacent site. The patients were treated with an arthroscopic debridement protocol consisting of (1) arthroscopic debridement and synovectomy, (2) suction drainage for 24 hours, (3) repeat arthroscopy for persisting clinical and laboratory findings and (4) antibiotics IV for four weeks and per.os. for two months (ciprofloxacin – rifampicin). The onset of the symptoms presented 18.2 days in average after the cause. The patients complained of swelling (18/18), fever ~39° C (16/18), stiffness (13/18), pain (12/18), erythema (6/18) and weakness (6/18). Arthroscopic drainage (average 1.5 procedures) was performed at an average of 8.4 days from the initiation of the symptoms. Laboratory data revealed elevated ESR (erythrocyte sedimentation rate) (average 68.9), CRP (average: 10.9) and WBC (average: 8894.3).
The mean follow-up period was 3.5 years. Cultures from knee joint aspirations were negative in 9 cases. Five knees were infected with Staphylococcus aureus, 2 with Staphylococcus epidermidis, 1 with Escherichia Coli and 1 with multiple organisms. One month after the last arthroscopic debridement, the ESR and CRP levels were normalised in all cases. Lysholm scores averaged 91. Most of the patients (15/18) returned to their pre-infection level of functioning. Overall success in clinical eradication of infection was 100%.
Our conclusions are:
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early aggressive arthroscopic debridement as part of a treatment protocol can be an effective treatment option,
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time is a crucial factor, and
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the earlier the arthroscopic debridement is performed, the better results are obtained.
Correspondence should be addressed to Vasiliki Boukouvala at Department of Orthopaedic Surgery & Traumatology, University Hospital of Larissa, 110 Mezourlo, Larissa, GREECE. Tel: +30 2410 682722, Fax: +30 2410 670107, Email: malizos@med.uth.gr
