Surgical and Functional outcome of Infective Knee Operated with Arthrotomy

Septic arthritis of the knee represents a significant orthopedic emergency, necessitating timely and effective intervention to avert irreversible joint destruction and potentially life-threatening systemic sequelae. Arthrotomy, involving open surgical drainage and meticulous debridement, continues to be the standard of care in cases with advanced infection, dense purulent collections, or where minimally invasive approaches such as arthroscopy are not viable. While this procedure is widely practiced, especially in resource-constrained settings, there remains a paucity of data regarding post-operative functional outcomes, complication rates, and long-term prognosis in the Indian clinical context. This gap highlights the need for region-specific research to guide clinical decision-making and optimize patient care in septic arthritis management.

The aim of the study was to evaluate the surgical and functional outcomes of arthrotomy in infected or septic knees using validated scoring systems, and to assess pain relief, complications, and recurrence post-surgery.

This prospective cohort study was conducted at a tertiary care center in Gujarat, India, over 18 months. A total of 30 adult patients with native joint infection underwent medial parapatellar arthrotomy. Functional outcomes were measured using the Knee Society Score (KSS) and Visual Analog Scale at 0, 6, 12, and 24 weeks postoperatively. Secondary parameters included range of motion, quality-of-life index, and microbiological culture results. Statistical analyses were performed using SPSS v29.

Among 30 patients (mean age 54 ± 14 years; 63% male), 60% had ≥1 comorbidity - most commonly hypertension (40%) and diabetes (33%). Baseline inflammatory markers were markedly elevated (erythrocyte sedimentation rate: 52 ± 15 mm/h; C-reactive protein: 82 ± 28 mg/L; total leukocyte count: 12.3 ± 3.5 × 10⁹/L). Clinical and functional KSSs improved significantly from 38 and 30 preoperatively to 88 and 84 at 24 weeks, respectively. Visual analogue pain scores declined from 8 ± 1 to 1 ± 1 over the same period. Culture-directed antibiotics followed empirical coverage with vancomycin or linezolid in 61% of cases. Post-operative complications were minimal (13%), with no deep infections, reoperations (3%), or mortality. Recurrence occurred in 7%, all methicillin-resistant Staphylococcus aureus-related. Compared to recent literature, outcomes were comparable or superior, supporting open arthrotomy as an effective, safe, and functionally restorative intervention in native knee septic arthritis.

Open arthrotomy for native knee septic arthritis offers excellent infection control, rapid pain relief, and significant functional recovery, even in elderly and comorbid populations. Low complication and reoperation rates, alongside outcomes comparable or superior to arthroscopic approaches, reinforce its continued role as a safe and definitive treatment modality in appropriately selected patients.