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

Johns, Brenton MBBS1; Loewenthal, Mark MBBS, M Med Sci, FRACP2,3; Ho, Eric MBBS, FRACS, FRCS1; Dewar, David MBBS, B Med Sci, FRACS(Ortho)1

The Pediatric Infectious Disease Journal: September 21, 2017 - Volume Publish Ahead of Print - Issue - p
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.

1The Bone and Joint Institute, Royal Newcastle Centre, Lookout Road, New Lambton Heights, NSW, Australia

2Department of Immunology and Infectious Diseases, Royal Newcastle Centre, Lookout Road, New Lambton Heights, NSW, Australia

3School of Medicine and Public Health, University of Newcastle, NSW, Australia

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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