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Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Septic arthritis is an orthopaedic emergency with high morbidity and mortality. The aim of this study is to determine the risk factors associated with secondary surgery for septic arthritis of the native knee joint.

Methods

This is a retrospective study reviewing all patients who underwent surgery for septic arthritis of the knee from 2012 to 2019 in a single institution. A total of 117 patients were recruited. Patients were divided into 2 groups: Group I (79/117, 67.5%) underwent one surgery and Group II (38/117, 32.5%) underwent more than one surgery.

Results

Patients with a raised initial total white (TW) cell count of > 20 × 109/L had a significantly higher risk of secondary surgery. (Adjusted hazard ratio 2.42, p < 0.05) A decline of CRP level of less than 20% within 24 h from initial operation was also a risk for secondary surgery. (Adjusted hazard ratio 0.34, p < 0.01) Patients in group II also had significantly higher post-operative median TW cell count and neutrophil count. There was no significant difference in the offending microbe, surgical approach, and duration of operation from initial presentation between the groups.

Conclusions

Patients with septic arthritis of the native knee joint who present with raised initial total white cell count of > 20 × 109/L and decline of CRP level of less than 20% within 24 h from initial operation are at higher risk of secondary operation. In these patients, more aggressive treatment strategies and appropriate counselling on the risks of repeated surgery are recommended.

Level of evidence

Level IV.

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Data availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

Code availability

The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to thank Ms. Gek Hsiang Lim and Ms. Acharyya Sanchalika for statistical support in the data analysis.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Tan Tock Seng Hospital Singapore, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Quan You Yeo, Ambrose Tsz Chun Li, Amit Nirmal Cuttilan, Jonathan Chee Chung Low & Sean Wei Loong Ho

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Contributions

QYY and SWLH contributed to the study conception and design. Material preparation, data collection and analysis were performed by QYY, ATCL, CAN and LCCJ. The first draft of the manuscript was written by QYY and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Quan You Yeo.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

Ethical approval

This research study was conducted retrospectively, and all the procedures being performed were part of the routine care. Data obtained were for clinical purposes. This retrospective study involving human participants was in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The Institutional Review Board (IRB) of National Healthcare Group, Singapore, approved this study with waiver of informed consent.

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There is wavier of consent to publication from IRB as all data were retrospectively collected with information anonymized. The submission does not include information or images that may identify any person.

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No consent to publication as all data were retrospectively collected with information anonymized. The submission does not include information or images that may identify any person.

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Yeo, Q.Y., Li, A.T.C., Cuttilan, A.N. et al. Raised initial total white cell count and lower post-operative decline of C reactive protein increases the risk of secondary surgery in septic arthritis of the native knee. Knee Surg Sports Traumatol Arthrosc 30, 3776–3783 (2022). https://doi.org/10.1007/s00167-022-07001-7

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