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Updated: Nov 16, 2025
Knee Arthrocentesis in Adults
Published on: February 25, 2022
Arthrocentesis, arthroscopy or arthrotomy for septic knee arthritis in children: a systematic review
Cornelia M Donders1, Anne J Spaans2, Johannes H J M Bessems3,4
1Department of Orthopaedic Surgery, Meander Medical Centre, Amersfoort, The Netherlands.
Insights
This systematic review suggests knee arthroscopy may be the most effective drainage technique for pediatric septic arthritis, potentially reducing the need for further procedures. Further high-quality research is warranted.
Area of Science:
- Pediatric Orthopedics
- Infectious Diseases
- Surgical Techniques
Background:
- Septic arthritis of the knee in children requires effective management to prevent joint damage.
- Treatment options include needle aspiration, arthroscopy, and arthrotomy, each with varying outcomes.
Purpose of the Study:
- To systematically review and identify the most effective drainage technique for septic arthritis of the knee in pediatric patients.
- To compare the outcomes of arthrocentesis, arthroscopy, and arthrotomy in treating pediatric knee septic arthritis.
Main Methods:
- A systematic search of PubMed, Embase, and Cochrane databases was conducted for relevant original articles.
- Eleven studies involving 279 knees were included, with study quality assessed using the Methodological Index for Non-Randomized Studies (MINORS) criteria.
- The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Main Results:
- Low-quality evidence (MINORS median 4) was found across the 11 included studies.
- A meta-analysis was not feasible due to study diversity and low quality.
- Additional drainage was required in 35% of knees after arthrocentesis, 4% after arthroscopy, and 17% after arthrotomy.
Conclusions:
- Current scientific literature on pediatric septic knee arthritis treatment is diverse and of generally low quality.
- Knee arthroscopy appears to have a lower risk of requiring additional drainage procedures compared to arthrocentesis and arthrotomy.
- Arthroscopy demonstrated acceptable clinical outcomes and no observed radiological sequelae in the reviewed studies.
Purpose:
Septic knee arthritis in children can be treated by arthrocentesis (articular needle aspiration) with or without irrigation, arthroscopy or arthrotomy followed by antibiotics. The objective of this systematic review was to identify the most effective drainage technique for septic arthritis of the knee in children.
Methods:
The electronic PubMed, Embase and Cochrane databases were systematically searched for original articles that reported outcomes of arthrocentesis, arthroscopy or arthrotomy for septic arthritis of the knee. The quality of all included studies was assessed with the Methodological Index for Non-Randomized Studies (MINORS) criteria. This systematic review was performed and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results:
Out of 2428 articles, 11 studies with a total of 279 knees were included in the systematic review. The quality of evidence was low (MINORS median 4 (2 to 7)). A meta-analysis could not be performed because of the diversity and low quality of the studies. In septic knee arthritis, additional drainage procedures were needed in 54 of 156 (35%) knees after arthrocentesis, in four of 96 (4%) after arthroscopy and in two of 12 (17%) after arthrotomy.
Conclusion:
Included studies on treatment strategies for septic arthritis of the knee in children are diverse and the scientific quality is generally low. Knee arthroscopy might have a lower risk of additional drainage procedures as compared with arthrocentesis and arthrotomy, with acceptable clinical outcomes and no radiological sequelae.
Level Of Evidence:
IV.
