A comparison of arthroscopy combined with continuous irrigation, arthroscopic debridement alone, and open arthrotomy for the treatment of septic arthritis of the native knee.

Background: The optimal surgical treatment for septic arthritis of the knee remains debatable, with few studies comparing different arthroscopic techniques. Furthermore, no study has simultaneously compared arthroscopy combined with continuous irrigation, arthroscopic debridement alone, and open arthrotomy. This study compared the efficacy and success rates of these three surgical methods and analyzed the risk factors for failure following initial surgery.

Methods: Data were collected from patients who underwent surgery for native knee septic arthritis at the 900th Hospital of Joint Logistic Support Force in China between 2013 and 2023. A retrospective comparison of demographics, comorbidities, auxiliary examination results, causes, microorganisms, and efficacy outcomes was made among the three surgical groups.

Results: A total of 65 patients (65 knees) were included in the study. All three groups had similar baseline characteristics. Postoperative C-reactive protein levels recovered faster in the continuous irrigation group than in the open group (p < 0.001). Both arthroscopic procedures showed a lower rate of hemoglobin decrease compared with open arthrotomy (p = 0.005 for the continuous irrigation group vs. open group; p = 0.023 for the debridement alone group vs. open group). The initial surgical success rate was higher in the continuous irrigation group (93.3%) than in the open group (65.2%) (p = 0.025). After adjusting for confounding factors through multivariate analysis, this advantage remained, with the risk of initial surgical failure in the open group being 11.31 times that in the continuous irrigation group (odds ratio = 11.31, 95% confidence interval: 1.7-75.24, p = 0.012). No significant differences were observed in postoperative range of motion, pain, or functional scores among the three groups.

Conclusion: No significant long-term functional differences were observed among the three surgical methods used to treat septic arthritis of the knee. The continuous irrigation group had an advantage in the early postoperative normalization of CRP levels and a higher initial surgical success rate than the open group.

Clinical Trial Number: Not applicable.