J Korean Orthop Assoc.  2021 Aug;56(4):310-316. 10.4055/jkoa.2021.56.4.310.

Effectiveness of Drain Insertion and Irrigation in the Treatment of Septic Arthritis of the Knee under Local Anesthesia

• Yi JW
• Oh BH
• Heo YM
• Jang MG
• Min YK
• Seo KD

• KMID: 2519122
• DOI: http://doi.org/10.4055/jkoa.2021.56.4.310

Abstract

Purpose
Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study examined the effectiveness of drain insertion and irrigation in the treatment of septic arthritis of the knee under local anesthesia.
Materials and Methods
A retrospective study was conducted on nine cases (eight patients) diagnosed with septic arthritis of the knee from September 2017 to February 2020 and treated with drain insertion and irrigation under local anesthesia. After penetrating through the superolateral portal to the superomedial portal and inserting the drain, daily irrigation of approximately 3 L of normal saline was done. The following were investigated: age, sex, underlying disease, cause, degree of osteoarthritis, time from diagnosis to surgery, duration of hospitalization, duration of normalization of C-reactive protein, and smear and culture.
Results
The initial white blood cell count of joint fluid was 71,472±51,667/mm³ (32,400–203,904/mm³ ), and polymorphic leukocytes were 91.1%±2.6% (86%–95%). The average time from diagnosis to surgery was 8.3±1.3 hours (6–10 hours), and the irrigation period was 8.2±3.2 days (4–15 days). The average length of hospitalization was 20.8±8.7 days (9–37 days). There was no reoperation or recurrence. Smear and culture tests were not identified.
Conclusion
In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under local anesthesia is a relatively fast and simple method to reduce pain by repetitive draining of purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

Keyword

septic arthritis; local anesthesia; drainage; knee joint