J Korean Orthop Assoc.  2019 Feb;54(1):30-36. 10.4055/jkoa.2019.54.1.30.

Prognostic Factors after Arthroscopic Treatment of Infectious Knee Arthritis

• Kang SW
• Choi ES
• Kim DS
• Jung HS
• Hong SH
• Go BS

• KMID: 2438957
• DOI: http://doi.org/10.4055/jkoa.2019.54.1.30

Abstract

PURPOSE
This study examined the effects of gender, age, underlying disease, duration after onset of symptoms, preoperative invasive procedures, bacterial culture of joint fluid, and stage of infection by the Gächter classification on the prognosis of patients with infectious knee arthritis who underwent arthroscopic surgery.
MATERIALS AND METHODS
From June 2014 to December 2016, 51 patients who underwent arthroscopic surgery for infective knee arthritis were enrolled in this study. The average follow-up period was 14.2±2.1 months (range, 12-20 months). The subjects were 27 men (52.9%) and 24 women (47.1%), with an average age of 55.1±17.6 years (range, 13-84 years). A preoperative evaluation of the joint aspiration with a count of more than 50,000 leukocytes and a polymorphonuclear leukocyte count of 95% or more was performed. All patients underwent arthroscopic surgery and postoperative continuous joint irrigation.
RESULTS
The initial mean value of the C-reactive protein decreased from 9.55±6.76 mg/dl (range, 1.51-31.06 mg/dl) to a final mean of 0.74±1.26 mg/dl (range, 0.08-6.77 mg/dl); the mean duration of C-reactive protein normalization was 27.6±18.9 days (range, 8-93 days). Among the 51 patients who received arthroscopic surgery and antibiotics, 44 patients (86.3%) with infectious knee arthritis completed treatment with improved clinical symptoms, such as fever, pain, and edema, and the C-reactive protein decreased to less than 0.5 mg/dl. Finally, 5 cases were treated with two or more arthroscopic operations, and 2 cases were converted to arthroplasty after prosthesis of antibiotic-loaded acrylic cement.
CONCLUSION
The duration of surgery after the onset of symptoms and the stage according to the Gächter classification are important prognostic factors for predicting the successful treatment of infectious knee arthritis. On the other hand, the other factors were not statistically significant. Nevertheless, patients with bacteria cultured from the joint fluids appear to reflect the treatment period because the period of normalization of the C-reactive protein is shorter than that of the control group.

Keyword

infectious knee arthritis; prognostic factor; arthroscopic treatment

MeSH Terms

Anti-Bacterial Agents
Arthritis*
Arthroplasty
Arthroscopy
Bacteria
C-Reactive Protein
Classification
Edema
Female
Fever
Follow-Up Studies
Hand
Humans
Joints
Knee*
Leukocytes
Male
Neutrophils
Prognosis
Prostheses and Implants
Anti-Bacterial Agents
C-Reactive Protein

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