Arthroscopic debridement of acute periprosthetic septic arthritis of the knee

Abstract

Purpose: To evaluate the efficacy of a treatment protocol including arthroscopic irrigation and debridement in resolving acute periprosthetic septic arthritis of the knee.

Type of study: Retrospective review.

Methods: During a 1-year period, patients presenting with acute septic arthritis of the knee after total knee arthroplasty were screened for suitability for treatment with an arthroscopic debridement protocol consisting of (1) arthroscopic debridement and synovectomy with at least 12 L of antibiotic irrigant, (2) suction drainage until minimum output, (3) repeat arthroscopy for fever persisting beyond 48 hours, and (4) intravenous antibiotics for 6 weeks. Only previously well-functioning arthroplasties presenting within 7 days of symptom onset in patients without immunocompromising factors and with radiographically stable prosthetic components were selected for this treatment protocol. Five knees in 4 patients met the inclusion criteria and were examined clinically and radiographically at minimum 36-month follow-up.

Results: The mean follow-up interval was 41 months (range, 36 to 43 months). No knee had been revised or had revision planned for infection, although 1 had undergone tibial insert exchange for polyethylene wear. Follow-up radiographs showed no prosthetic loosening, and Knee Society scores averaged 88 (range, 75-95) in the 4 retained knees, 3 of which were subjectively thought to have returned to their preinfection level of functioning. All knees were infected with a single organism not considered highly virulent. No patients required oral suppressive antibiotics for their knees.

Conclusions: Early aggressive arthroscopic debridement as part of a treatment protocol of acute periprosthetic knee septic arthritis with well-fixed and functioning implants can be an effective treatment option in selected cases.

Level of evidence: Level IV study (no, or historical control group).