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Arthroscopic irrigation and debridement is associated with favourable short-term outcomes vs. open management: an ACS-NSQIP database analysis

  • KNEE
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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

Septic arthritis of the knee is an orthopaedic emergency that is associated with marked morbidity and can potentially be life threatening. Surgical debridement can be performed either arthroscopically or via an arthrotomy. The aim of this study was to compare the 30-day complications and adverse outcomes between the two procedures.

Methods

Patients with a diagnosis of septic arthritis of the knee between 2011 and 2015 were identified using the ACS-NSQIP database. The study population included 695 patients, who had knee septic arthritis and underwent either an arthroscopic irrigation or debridement (I&D) (n = 464) or open irrigation and debridement (n = 231). Preoperative data included demographics, independent functional status, and comorbidities. Outcomes of interest included wound complications, infectious complications, cardiovascular events, hospital readmissions, and reoperations, or any of the previous adverse events.

Results

Both cohorts were similar in most baseline characteristics. Bleeding requiring transfusion was significantly lower in the arthroscopic (n = 13; 3.6%) compared to the open procedure (n = 31; 13.4%; p = 0.0001). Home discharge was significantly higher in the arthroscopic irrigation and debridement group (n = 310; 67.5%) compared to the open group (n = 126; 55%; p = 0.0013). The overall incidence of adverse events was lower in the arthroscopic group (n = 158; 34%) compared to the open group (n = 112; 49%; p = 0.0002). There was no difference in rates of infectious complications, thromboembolic events, hospital readmission, reoperation, or mortality between the groups. Open irrigation and debridement was associated with higher risk of bleeding requiring transfusion (OR = 3.79; 95% CI: 2.02–7.13; p = 0.0001), higher risk of incidence of adverse events (OR = 1.46; 95% CI: 1.02–2.08; p = 0.039), and lower home discharge (OR = 3.79; 95% CI: 2.02–7.13; p = 0.0001) within 30 days after the procedure.

Conclusion

Arthroscopic irrigation and debridement demonstrated favourable short-term outcomes. Patients who underwent arthroscopic irrigation and debridement had lower rates of blood transfusions, lower rates of adverse events, and higher home discharge rates compared to open irrigation and debridement. This study is the largest analysis comparing arthroscopic vs. open irrigation and debridement in a national database sample. These findings conclude that arthroscopic debridement can be an alternative first-line option in managing septic arthritis.

Level of evidence

III.

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Abbreviations

ACS-NSQIP:

American College of Surgeons National Surgical Quality Improvement Program

I&D:

Incision and drainage

OR:

Odds ratio

CI:

Confidence interval

SD:

Standard deviation

BMI:

Body mass index

ICD-9:

International Classification of Disease, 9th edition

CPT:

Current Procedural Technology code

UTI:

Urinary tract infection

n.s.:

Non-significant

DVT:

Deep vein thrombosis

PE:

Pulmonary embolism

ASA:

American Society of Anesthesiologists

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Acknowledgements

American College of Surgeons National Surgical Quality Improvement Program and the hospitals participating in the ACS-NSQIP are the source of the data used herein; they have not verified and are not responsible for the statistical validity of the data analysis or the conclusions derived by the authors.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Mhamad Faour, Assem A. Sultan, Jaiben George, Linsen T. Samuel, Gannon L. Curtis & Robert Molloy

  2. Department of Orthopaedic Surgery, Cleveland Clinic Florida, Weston, FL, USA

    Carlos A. Higuera

  3. Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY, USA

    Michael A. Mont

Authors
  1. Mhamad Faour
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  2. Assem A. Sultan
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  3. Jaiben George
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  4. Linsen T. Samuel
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  5. Gannon L. Curtis
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  6. Robert Molloy
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  7. Carlos A. Higuera
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  8. Michael A. Mont
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Contributions

MF conceived of the study and drafted the manuscript; JG participated in the design of the study and performed the statistical analysis; AS participated in its design and coordination and helped to draft the manuscript. LTS participated in its design and coordination and helped to draft the manuscript; GLS participated in its design and coordination and helped to draft the manuscript; RM participated in its design and coordination; CAH participated in its design and coordination; and MAM participated in its design and coordination. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Michael A. Mont.

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Conflict of interest

Mhamad Faour, MD, declares that he has no competing interests. Assem Sultan, MD, declares that he has no competing interests. Jaiben George, MD, declares that he has no competing interests. Linsen T. Samuel, MD, MBA, declares that he has no competing interests. Gannon L. Curtis, MD, declares that he has no competing interests. Robert Molloy, MD: Stryker: paid consultant; Paid presenter or speaker; research support. Zimmer: research support. Carlos A. Higuera, MD: 3M: research support. American Association of Hip and Knee Surgeons: Board or committee member. American Journal of Orthopedics: editorial or governing board. CD Diagnostics: research support. Cempra: research support. Cymedica: research support. Ferring pharmaceuticals: research support. Journal of Hip Surgery: editorial or governing board. Journal of Knee Surgery: Editorial or governing board. KCI: paid consultant; paid presenter or speaker; research support. Mid-American Orthopaedic Association: board or committee member. Musculoskeletal Infection Society: board or committee member. OREF: research support. Orthofix, Inc.: research support. Pfizer: paid consultant. PSI: stock or stock options. Stryker: research support. TenNor Therapeutics Limited: paid consultant. Zimmer: paid consultant; research support. Michael A. Mont, MD. AAOS: board or committee member. Abbott: paid consultant. Cymedica: paid consultant. DJ Orthopaedics: paid consultant; research support. Johnson & Johnson: paid consultant; research support. Journal of Arthroplasty: editorial or governing board. Journal of Knee Surgery: editorial or governing board. Mallinckrodt Pharmaceuticals: paid consultant. Microport: IP royalties. National Institutes of Health (NIAMS & NICHD): research support. Ongoing Care Solutions: paid consultant; research support. Orthopedics: editorial or governing board. Orthosensor: paid consultant; research support. Pacira: paid consultant. Peerwell: stock or stock options. Performance Dynamics Inc.: paid consultant. Sage: paid consultant. Stryker: IP royalties; paid consultant; research support. Surgical Techniques International: editorial or governing board. TissueGene: paid consultant; research support.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Faour, M., Sultan, A.A., George, J. et al. Arthroscopic irrigation and debridement is associated with favourable short-term outcomes vs. open management: an ACS-NSQIP database analysis. Knee Surg Sports Traumatol Arthrosc 27, 3304–3310 (2019). https://doi.org/10.1007/s00167-018-5328-1

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