Treatment of septic knee arthritis: Comparison of arthroscopic debridement alone or combined with continuous closed irrigation-suction system

Background: Arthroscopic debridement has been widely adapted as initial treatment for septic knee arthritis. Although isolated cases of arthroscopic debridement combined with irrigation-suction systems have been reported, a comparison of two techniques has not been performed, to our knowledge. The purpose of this study was to compare the two methods of treatment. Methods: From January 1996 to December 2008, 39 patients with 39 septic knee arthritis treated in our institution were retrospectively analyzed. Nineteen knees were initially treated with arthroscopic debridement alone (group I), and 20 knees were initially treated with arthroscopic debridement combined with continuous closed irrigation-suction system (group II). The clinical presentation, laboratory and microbiologic findings, hospital course, and clinical outcomes were compared between the two groups. Results: The mean delay between the onset of the symptoms and treatment had a significant effect on the clinical outcomes. When the comparison included all the patients in the series, no significant difference between the two groups was found with regard to the number of operation procedures required or the length of the hospital stay. However, when the comparison was separated from the initial stage of infection, it was found that in stage II infection, patients had fewer reoperations and in stages II and III infection, a shorter hospital stay in group II than in group I (p < 0.05). There was no significant difference in the functional results between the two groups. Conclusions: The early diagnosis and aggressive initiation of treatment carried the success of therapy in septic knee arthritis. Arthroscopic debridement combined with continuous closed irrigation-suction system is an effective treatment for patients with septic knee arthritis; these patients had fewer operations and a shorter hospital stay than did patients who had received arthroscopic debridement alone.