J Korean Orthop Assoc.  2022 Dec;57(6):482-489. 10.4055/jkoa.2022.57.6.482.

Is the Insertion of a Drain Tube and Irrigation as Effective as Arthroscopic Synovectomy in Treating Septic Arthritis of the Knee?

• Kwon KH
• Chung YW
• An KY
• Kim GS
• Ahn JH

• KMID: 2537061
• DOI: http://doi.org/10.4055/jkoa.2022.57.6.482

Abstract

Purpose
Septic arthritis of the knee is an orthopedic emergency that requires early diagnosis and surgical treatment. This study compared the effectiveness of the insertion of a drain tube and irrigation under a femoral nerve block with that of knee arthroscopic synovectomy for the treatment of septic arthritis of the knee.
Materials and Methods
A retrospective study was conducted on 60 cases diagnosed with septic arthritis of the knee from March 2017 to October 2021. Thirty cases (group A) were treated with drain insertion and irrigation, and 30 (group B) were treated with knee arthroscopic synovectomy. The following parameters were investigated: age, sex, underlying disease, cause, white blood cell (WBC) count, C-reactive protein (CRP), erythrocyte sedimentation rate of the serum and WBC count, polymorphonuclear neutrophil leukocytes of joint fluid, time from diagnosis to surgery. duration of the operation time, duration of hospitalization, duration of normalization of CRP, recurrence rate, and duration of using antibiotics.
Results
There was no significant difference in the length of hospitalization, time of normalization of the CRP, and duration of using antibiotics between the two groups, but significant differences were noted in the time from diagnosis to surgery and recurrence rate. The time from diagnosis to surgery was nine hours on average in group A (insertion of a drain tube and irrigation). When treated with arthroscopic synovectomy, the average time from diagnosis to surgery was 12 hours. The recurrence rate was higher in group A (33%) than in group B (17%).
Conclusion
In the treatment of septic arthritis of the knee, the insertion of a drain tube and irrigation under femoral nerve block anesthesia is a relatively fast and straightforward method to reduce pain by draining the purulent joint fluid and can be used as an alternative treatment for patients with a risk of general or spinal anesthesia.

Keyword

infectious arthritis; nerve block; synovectomy