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Arthroscopic Versus Open Treatment for Acute Septic Arthritis of the Knee in Children

Johns, Brenton MBBS; Loewenthal, Mark MBBS, M Med Sci, FRACP; Ho, Eric MBBS, FRACS, FRCS; Dewar, David MBBS, B Med Sci, FRACS(Ortho)
The Pediatric Infectious Disease Journal: Post Acceptance: September 21, 2017
doi: 10.1097/INF.0000000000001795
Original Studies: PDF Only

Background:

Acute septic arthritis of the knee in children may be treated by arthroscopic or open methods however paediatric data comparing these methods is limited regarding both short and long-term outcomes. This study aimed to compare outcomes following arthroscopic versus open surgery for acute paediatric septic knee arthritis.

Methods:

Paediatric patients with acute knee septic arthritis treated at our institution from 1996 to 2016 were retrospectively assessed. The clinical presentations, operations, micro-organisms, laboratory results, knee radiological findings and antibiotics administered were compared. Patients long-term outcomes were assessed at mean 6.9 (range 1.1–20.3) years.

Results:

Twenty-four patients met the inclusion criteria. Eleven patients received arthroscopic irrigation and 13 had open irrigation. Five patients in the open group (38.5%) required a second irrigation compared to none in the arthroscopic group (95% C.I. 12%–65%, p = 0.041). Time to range the knee occurred earlier in the arthroscopic group (5.0 days; arthroscopic vs 10.6 days; open, difference 5.6 days: 95% C.I. 0.84–10.3, p = 0.023) as well as weightbearing (2.7 days; arthroscopic vs 10.3 days; open, difference 7.6 days: 95% C.I. 2.3–12.9, p = 0.008). Eighty-three percent of patients attended followup. No infections recurred. No significant differences were found in KOOS-Child scores, Lysholm scores, ROM, leg length, gait and radiological findings.

Conclusions:

For acute paediatric septic knee arthritis arthroscopic irrigation is associated with less repeat surgical irrigations and allows earlier knee ranging and weightbearing compared to open irrigation. At long-term followup no significant difference was found between groups.

Conflicts of Interest and Disclosures: The authors have no conflicts of interest or funding to disclose. Also, the authors have not received funding from National Institutes of Health (NIH); Wellcome Trust; Howard Hughes Medical Institute (HHMI); and other(s).

Sources of Support: This study did not receive any sources of support. The authors have no other sources of support to report.

Corresponding Author: Dr. Brenton Johns, MBBS, The Bone and Joint Institute , Royal Newcastle Centre, Lookout Road, New Lambton Heights, NSW, 2305, Australia. Ph: (02) 49213000. E-mail: brentonpjohns@gmail.com. Fax: 49693211

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