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Published on: February 25, 2022
Arthroscopic Versus Open Treatment for Acute Septic Arthritis of the Knee in Children
Brenton Johns1, Mark Loewenthal2,3, Eric Ho1
1From the The Bone and Joint Institute.
Insights
Arthroscopic knee surgery for septic arthritis in children leads to fewer repeat procedures and faster recovery than open surgery. Long-term outcomes are comparable between the two surgical methods for pediatric septic knee arthritis.
Area of Science:
- Pediatric Orthopedics
- Pediatric Infectious Diseases
- Surgical Outcomes Research
Background:
- Acute septic arthritis of the knee in children presents treatment challenges.
- Limited pediatric data exists comparing arthroscopic and open surgical outcomes.
- This study addresses the need for comparative outcome data in pediatric septic knee arthritis.
Purpose of the Study:
- To compare short- and long-term outcomes of arthroscopic versus open surgery for acute pediatric septic knee arthritis.
- To evaluate the efficacy and safety of different surgical approaches.
- To provide evidence-based guidance for treating pediatric septic knee arthritis.
Main Methods:
- Retrospective assessment of pediatric patients with acute knee septic arthritis (1996-2016).
- Comparison of clinical presentations, surgical procedures, microorganisms, laboratory results, and antibiotic use.
- Long-term outcomes assessed at a mean of 6.9 years post-treatment.
Main Results:
- Arthroscopic irrigation (11 patients) resulted in no repeat irrigations, compared to 38.5% in the open group (13 patients).
- Earlier knee range of motion and weight-bearing were observed in the arthroscopic group.
- No significant differences in long-term outcomes, including functional scores and radiographic findings, were found between groups.
Conclusions:
- Arthroscopic irrigation for pediatric septic knee arthritis is associated with reduced need for repeat surgery.
- Arthroscopic approach facilitates earlier knee ranging and weight-bearing compared to open surgery.
- Both methods yield comparable long-term outcomes for acute pediatric septic knee arthritis.
Background:
Acute septic arthritis of the knee in children may be treated by arthroscopic or open methods; however, pediatric data comparing these methods is limited regarding both short- and long-term outcomes. This study aimed to compare outcomes after arthroscopic versus open surgery for acute pediatric septic knee arthritis.
Methods:
Pediatric patients with acute knee septic arthritis treated at our institution from 1996 to 2016 were retrospectively assessed. The clinical presentations, operations, microorganisms, laboratory results, knee radiologic findings and antibiotics administered were compared. Patients' long-term outcomes were assessed at mean 6.9 (range 1.1-20.3) years.
Results:
Twenty-four patients met the inclusion criteria. Eleven patients received arthroscopic irrigation and 13 had open irrigation. Five patients in the open group (38.5%) required a second irrigation compared with none in the arthroscopic group [95% confidence interval (CI): 12%-65%; P = 0.041]. Time to range the knee occurred earlier in the arthroscopic group (5.0 days; arthroscopic vs. 10.6 days; open, difference 5.6 days: 95% CI: 0.84-10.3, P = 0.023), as well as weight-bearing (2.7 days; arthroscopic vs. 10.3 days; open, difference 7.6 days: 95% CI: 2.3-12.9, P = 0.008). Eighty-three percent of patients attended follow-up. No infections recurred. No significant differences were found in Knee injury and Osteoarthritis Outcome Scores for children, Lysholm scores, range-of-motion, leg length, gait and radiologic findings.
Conclusions:
For acute pediatric septic knee arthritis, arthroscopic irrigation is associated with less repeat surgical irrigations and allows earlier knee ranging and weight-bearing compared with open irrigation. At long-term follow-up, no significant difference was found between groups.
