search for




 

A comparative analysis of results between antibiotic therapy alone and combined with arthroscopic lavage for low-grade pyogenic arthritis of the knee
Arthrosc Orthop Sports Med 2017;4:74-80
Published online July 1, 2017;  https://doi.org/10.14517/aosm17005
© 2017 Korean Arthroscopy Society and Korean Orthopedic Society for Sports Medicine.

Yu-Hun Jung, Woo-Suk Song, Dong-Chan Eun, Sang-Jun Park

Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, Seongnam, Korea
Correspondence to: Dong-Chan Eun,
Department of Orthopedic Surgery, Bundang Jesaeng General Hospital, Daejin Medical Center, 20 Seohyeon-ro 180beon-gil, Bundang-gu, Seongnam 13590, Korea.
Tel: +82-31-779-0175, Fax: +82-31-779-0179, E-mail: eundongchan@naver.com
Received April 10, 2017; Revised June 21, 2017; Accepted June 21, 2017.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: This study aims to compare the results between antibiotic therapy alone and combined with arthroscopic lavage in patients with low-grade pyogenic arthritis of the knee.
Methods: Patients with low-grade pyogenic arthritis of the knee were defined as those with symptoms of acute pyogenic arthritis but with a white blood cell count of 20,000 to 50,000/mm3 in the synovial fluid and a polymorphonuclear neutrophil level of 50% to 90%. We analyzed a total of 124 patients retrospectively. Patients treated using antibiotic monotherapy were categorized as Group A, and those treated using antibiotic therapy combined with arthroscopic lavage, as Group B. We compared parameters such as the duration of antibiotic injection, length of hospitalization, and recovery of the range of motion. Clinical outcome, measured as the Lysholm score and the visual analogue scale (VAS) score, was also compared.
Results: We found that the parameters duration of antibiotic injection, length of hospital stay, and recovery of range of motion of the knee were significantly better in Group A than in Group B. However, the clinical outcome, denoted by the Lysholm knee score and the VAS score, did not significantly differ between the two treatment groups.
Conclusion: We conclude that in patients with low-grade pyogenic arthritis of the knee early antibiotic therapy alone shows more satisfactory results than antibiotic therapy combined with arthroscopic lavage. Thus, our findings suggest that antibiotic monotherapy should be considered without any adjunct procedures such as arthroscopic lavage.
Keywords : Pyogenic arthritis; Antibacterial agents; Arthroscopes
References
  1. The Korean Orthopaedic Association. Orthopaedics. 7th ed. Seoul: Choishineuihaksa; 2013. p.353-5.
  2. Shirtliff ME, Mader JT. Acute septic arthritis. Clin Microbiol Rev 2002;15:527-44.
    KoreaMed CrossRef
  3. Mathews CJ, Kingsley G, Field M, et al. Management of septic arthritis: a systematic review. Ann Rheum Dis 2007;66:440-5.
    Pubmed KoreaMed
  4. Weston VC, Jones AC, Bradbury N, Fawthrop F, Doherty M. Clinical features and outcome of septic arthritis in a single UK Health District 1982-1991. Ann Rheum Dis 1999;58:214-9.
    Pubmed KoreaMed CrossRef
  5. Carpenter CR, Schuur JD, Everett WW, Pines JM. Evidence-based diagnostics: adult septic arthritis. Acad Emerg Med 2011;18:78196.
    Pubmed KoreaMed CrossRef
  6. Ateschrang A, Albrecht D, Schroeter S, Weise K, Dolderer J. Current concepts review: septic arthritis of the knee pathophysiology, diagnostics, and therapy. Wien Klin Wochenschr 2011;123:191-7.
    Pubmed CrossRef
  7. Coutlakis PJ, Roberts WN, Wise CM. Another look at synovial fluid leukocytosis and infection. J Clin Rheumatol 2002;8:67-71.
    Pubmed CrossRef
  8. Stengel D, Bauwens K, Sehouli J, Ekkernkamp A, Porzsolt F. Systematic review and meta-analysis of antibiotic therapy for bone and joint infections. Lancet Infect Dis 2001;1:175-88.
    CrossRef
  9. Kim SJ, Choi NH, Ko SH, Linton JA, Park HW. Arthroscopic treatment of septic arthritis of the hip. Clin Orthop Relat Res 2003;(407):211-4.
    Pubmed CrossRef
  10. Chung WK, Slater GL, Bates EH. Treatment of septic arthritis of the hip by arthroscopic lavage. J Pediatr Orthop 1993;13:444-6.
    Pubmed CrossRef
  11. Le Dantec L, Maury F, Flipo RM, et al. Peripheral pyogenic arthritis. A study of one hundred seventy-nine cases. Rev Rhum Engl Ed 1996;63:103-10.
    Pubmed
  12. Jeon YD, Moon JY, Son JH, Kim JM, Choi Y. The efficacy of arthroscopic debridement with continuous irrigation in failed arthroscopic debridement for septic arthritis of the knee. J Korean Orthop Assoc 2016;51:308-14.
    CrossRef
  13. Balabaud L, Gaudias J, Boeri C, Jenny JY, Kehr P. Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc 2007;15:387-92.
    Pubmed CrossRef
  14. Wirtz DC, Marth M, Miltner O, Schneider U, Zilkens KW. Septic arthritis of the knee in adults: treatment by arthroscopy or arthrotomy. Int Orthop 2001;25:239-41.
    Pubmed KoreaMed CrossRef
  15. Dave OH, Patel KA, Andersen CR, Carmichael KD. Surgical procedures needed to eradicate infection in knee septic arthritis. Orthopedics 2016;39:50-4.
    Pubmed CrossRef
  16. Peres LR, Marchitto RO, Pereira GS, Yoshino FS, de Castro Fernandes M, Matsumoto MH. Arthrotomy versus arthroscopy in the treatment of septic arthritis of the knee in adults: a randomized clinical trial. Knee Surg Sports Traumatol Arthrosc 2016;24:3155-62.
    Pubmed CrossRef
  17. Vispo Seara JL, Barthel T, Schmitz H, Eulert J. Arthroscopic treatment of septic joints: prognostic factors. Arch Orthop Trauma Surg 2002;122:204-11.
    Pubmed CrossRef
  18. Stutz G, Kuster MS, Kleinstück F, Gächter A. Arthroscopic management of septic arthritis: stages of infection and results. Knee Surg Sports Traumatol Arthrosc 2000;8:270-4.
    Pubmed CrossRef
  19. Gachter A. Joint infection-arthroscopic lavage-hints and tricks. Arthroskopie 1994;7:98-102.