Arthroscopy in the treatment of knee septic arthritis

Objective: to evaluate the use of arthroscopic irrigation in the treatment of septic arthritis of the knee joint. Methods: This case series study. Was conducted in Al-Jamhori Teaching Hospital in Mosul, from August 2003 to December 2005, on twenty patients with septic arthritis of knee joint who presented with pain, fever, swelling and limitation of movements of their affected knee joint. The mean age of the patients was 31.5 years, and the female to male ratio was 1:1.5. Arthroscopic irrigation was arranged within 24 hours of admission, suction drain used, with the use of intravenous antibiotic for 7 days then change to oral antibiotic for 5-6 weeks. laboratory investigation and X-ray were done, aspiration of synovial fluid was send for analysis, direct gram stain, culture and sensitivity. Results: Synovial biopsy confirmed the diagnosis and showed typical changes of septic arthritis. We achieved 60% excellent, 30% good and 10% acceptable results of the knee joint depending on clinical evaluation and laboratory investigation. Most of patients were delayed in presentation. Staphylococcus aureus was the commonest causative organism. Conclusion: Arthroscopic irrigation of knee joint has encouraging results in the treatment of septic knee with low incidence of complications. ةصلاخلا : يجمخلا ةبآرلا لصفم باهتللا ةيراظنملا ةجلاعملا فدهلا : يجمخلا ةبآرلا لصفم باهتلا ةجلاعم يف يراظنملا ضحرلا مييقت . ميمصتلا : م تلااح ةسارد ةعباتت . ناكملا : يف ةساردلا تيرجأ لا بآ نم ةرتفلل لصوملا يف يميلعتلا يروهمجلا ىفشتسم ٢٠٠٣ لولأا نوناآ ىلإ ٢٠٠٥ م . نوآراشملا : نورشع ضيرم اً يجمخلا ةبآرلا لصفم باهتلا نم نوكشي , ملالآا نم نوناعي , ةجرد يف عافترا ةرارحلا , صملا ةبآرلا لصفم تاآرح يف ددحتو مروت ةبا . قرطلا : عرزلاو ليلحتلا ىلإ اهلاسرإو ةبآرلا لئاوس طفسو ةيعاعشلا قئاقرلاو ةيربتخملا تاءاصقتسلاا تيرجأ ةيساسحلاو . للاخ بتر يراظنملأ ضحرلا ٢٤ لصفملا ةناطب نم عزخ ذخا عم ضيرملا لوخد نم ةعاس . ةيويح تادصم مادختسا عم يفاشترا فرصم مدختسا . جئاتنلا : افترا اندجو ثحتسملا يس نيتوربو رمحلا مدلا تايرآ لقثت لدعم يف ع . ضيبلا مدلا تايرآ ددع عافتراو عئاشلا ببسملا يه ةيلاقتربلا ةيدوقنعلا تاروكملا تناآو باسحلا دح ةزواجتم يلصفملا لئاسلا يف . جئاتن انققح ٦٠ % و زاتمم ٣٠ % و ديج ١٠ % قتسلااو يريرسلأ مييقتلا ىلع نيدمتعم ايفيظو لوبقم ةيربتخملا تاءاص . ناآ ةجلاعملا و صيخشتلا يف نيرخأتم ىضرملا بلغا . جاتنتسلاا : تافعاضملا نم لقا ةبسن عم يحارجلا لخادتلل ديج ليدب وه ةبآرلا لصفمل يراظنملأ ضيحرتلا . 7 , 200 &2 No. 1 3 Vol. 3 Annals of the College of Medicine Mosul College of Medicine 7 © 200 21 eptic arthritis is an orthopedic emergency that can lead to rapid joint destruction and irreversible loss of function with both significant morbidity and mortality which result from bacterial invasion of joint space . The most commonly involved joint is the knee (50%of cases). The major consequence of bacterial invasion is damage to articular cartilage. These destructive processes are well advanced as early as 3 days into the course of untreated infection . Septic arthritis of the knee joint may present with pain, fever, swelling, tenderness, warmth, effusion, and impaired joint movement. Arthroscopic lavage has been used increasingly in the management of septic arthritis. The advantages are that extensive debridement can be performed with a small incision and there is a more rapid recovery period and the patient needs short term hospitalization . With early onset of therapy, arthroscopic treatment leads to an effective resolution of infection with better functional results than open arthrotomy 13, . The aim of this study is to evaluate the use of arthroscopic irrigation in the treatment of septic arthritis of the knee joint and to present pattern of septic arthritis of the knee joint in our community. Patients and methods Twenty patients with septic arthritis of the knee joint were treated by arthroscopic treatment. The study was carried out in AlJamhori Teaching Hospital in Mosul between August 2003 and December 2005. Full history of illness was taken and detailed clinical examination performed. Aspiration of the joint and synovial fluid analysis including culture and sensitivity, serological examination, WBC count, differential count, ESR, CRP, and radiographs were done. All patients received broads spectrum antibiotics intravenously in divided dose after aspiration until the result of culture and sensitivity was obtained. Arthroscopy was done in operating room under general anesthesia through anterolateral approach. Examination of the knee begins first. During the procedure we use the high flow irrigation using (5) liter of ringer lactate and suction sheath connected to negative pressure sucker. The high flow irrigation is used to distend the joint, to clear any debris, to release adhesions, and to clear the joint from the toxic material produced by bacteria and polymorphonuclear leukocytes. Biopsy taken from the synovium, suction drain left, and dressing with RobertJones bandage. Parenteral analgesic and intravenous antibiotics were given to the patients postoperatively, and patients encouraged doing quadriceps exercises. The suction drain being inspected and also the amount of the fluid collected. Mobilization of the patient out of bed on crutches was allowed as soon as the circumstances of the patient permitted. At the 3 day, the wound was inspected and the suction drain removed and more active exercises allowed. Full weight bearing was allowed (14) days after the operation and stronger active exercise encouraged. The follow up regimen continued every week for (8 weeks) or until the patient is completely normal. The cured patients were advised to visit us every (8 weeks) for physical and laboratory evaluation. The last outcome results were classified to four grades according to the last clinical examination: "Excellent" normal movements, no pain, no swelling and no instability (resolution): "Good" no pain, few degrees of limitation in movements, no swelling and no instability. "Accepted": occasional pain, some limitation of movements, 10-20 degrees, stable joint and mild swelling; "Poor": painful joint, marked stiffness, persisted swelling; and instability.