Knee Septic Arthritis after Arthroscopy: Incidence, Risk Factors, Functional Outcome, and Infection Eradication Rate

Abstract

Purpose Septic knee arthritis following arthroscopy is a rare but dreaded complication. Definition and management of knee deep infections are quite discussed in literature. In this review, literature regarding infections after knee arthroscopy is analyzed highlighting the incidence, causative bacteria, risk factors as well as clinical outcomes.

Methods We performed a review of the literature matching the following key words: “septic arthritis” OR “infection” AND “arthroscopy” AND “knee.” Knee arthroscopic procedures, such as debridement, meniscectomy, meniscus repair, synovectomy, microfracture, and lateral release, were considered. Complex procedures, such as ligament reconstruction, fractures, or complex cartilage repair techniques, were not included.

Results Thirteen studies were included in this review. Incidence of infection ranged from 0.009 to 1.1% in patients undergoing simple arthroscopic procedures. Staphylococci are the most commonly isolated organisms from postarthroscopy infection. Use of intraoperative intra-articular steroids, smoking, obesity, male sex, diabetes, number of procedures performed during surgery, time of surgery, and tourniquet time of more than 60 minutes have been certified as risk factors for knee infection.

Conclusion Postarthroscopy septic arthritis of the knee causes significant morbidity, usually requiring readmission to the hospital, at least one additional operation, and prolonged antibiotic therapy, both intravenous and oral. Prompt diagnosis and treatment are associated with a high success rate.

Level of Evidence Level IV, systematic review of I-IV studies.

Keywords

infection - septic arthritis - knee - arthroscopy - risk factors

• References

• 1 Kim S, Bosque J, Meehan JP, Jamali A, Marder R. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93 (11) 994-1000
• 2 Lubowitz JH, Ayala M, Appleby D. Return to activity after knee arthroscopy. Arthroscopy 2008; 24 (01) 58-61.e4
• 3 Johnson LL, Shneider DA, Austin MD, Goodman FG, Bullock JM, DeBruin JA. Two per cent glutaraldehyde: a disinfectant in arthroscopy and arthroscopic surgery. J Bone Joint Surg Am 1982; 64 (02) 237-239
• 4 Bert JM, Giannini D, Nace L. Antibiotic prophylaxis for arthroscopy of the knee: is it necessary?. Arthroscopy 2007; 23 (01) 4-6
• 5 Armstrong RW, Bolding F, Joseph R. Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors. Arthroscopy 1992; 8 (02) 213-223
• 6 Armstrong RW, Bolding F. Septic arthritis after arthroscopy: the contributing roles of intraarticular steroids and environmental factors. Am J Infect Control 1994; 22 (01) 16-18
• 7 Sherman OH, Fox JM, Snyder SJ. , et al. Arthroscopy--“no-problem surgery”. An analysis of complications in two thousand six hundred and forty cases. J Bone Joint Surg Am 1986; 68 (02) 256-265
• 8 DeLee JC, Elliot B, Fiddan N. , et al; Committee on Complications of Arthroscopy Association of North America. Complications of arthroscopy and arthroscopic surgery: results of a national survey. Arthroscopy 1985; 1 (04) 214-220
• 9 Small NC, Cohen S, Ehlich G. , et al; Committee on Complications of the Arthroscopy Association of North America. Complications in arthroscopy: the knee and other joints. Arthroscopy 1986; 2 (04) 253-258
• 10 Balabaud L, Gaudias J, Boeri C, Jenny JY, Kehr P. Results of treatment of septic knee arthritis: a retrospective series of 40 cases. Knee Surg Sports Traumatol Arthrosc 2007; 15 (04) 387-392
• 11 Yeranosian MG, Petrigliano FA, Terrell RD, Wang JC, McAllister DR. Incidence of postoperative infections requiring reoperation after arthroscopic knee surgery. Arthroscopy 2013; 29 (08) 1355-1361
• 12 Hagino T, Ochiai S, Watanabe Y. , et al. Complications after arthroscopic knee surgery. Arch Orthop Trauma Surg 2014; 134 (11) 1561-1564
• 13 Ashraf A, Luo TD, Christophersen C, Hunter LR, Dahm DL, McIntosh AL. Acute and subacute complications of pediatric and adolescent knee arthroscopy. Arthroscopy 2014; 30 (06) 710-714
• 14 Clement RC, Haddix KP, Creighton RA, Spang JT, Tennant JN, Kamath GV. Risk factors for infection after knee arthroscopy: analysis of 595,083 cases from 3 United States databases. Arthroscopy 2016; 32 (12) 2556-2561
• 15 Wyatt RW, Maletis GB, Lyon LL, Schwalbe J, Avins AL. Efficacy of prophylactic antibiotics in simple knee arthroscopy. Arthroscopy 2017; 33 (01) 157-162
• 16 Montgomery SC, Campbell J. Septic arthritis following arthroscopy and intra-articular steroids. J Bone Joint Surg Br 1989; 71 (03) 540–540
• 17 Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. ; Hospital Infection Control Practices Advisory Committee. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999; 20 (04) 250-278 ; quiz 279–280
• 18 Babcock HM, Matava MJ, Fraser V. Postarthroscopy surgical site infections: review of the literature. Clin Infect Dis 2002; 34 (01) 65-71
• 19 Bert JM, Bert TM. Management of infections after arthroscopy. Sports Med Arthrosc Rev 2013; 21 (02) 75-79
• 20 Pagliano P, Costantini S, Gradoni L. , et al. Distinguishing visceral leishmaniasis from intolerance to pegylated interferon-alpha in a thalassemic splenectomized patient treated for chronic hepatitis C. Am J Trop Med Hyg 2008; 79 (01) 9-11
• 21 Pagliano P, Carannante N, Gramiccia M. , et al. Visceral leishmaniasis causes fever and decompensation in patients with cirrhosis. Gut 2007; 56 (06) 893-894
• 22 Ascione T, Balato G, Pagliano P. Perspective: How to deal with fever (38°C) after arthroplasty: the infectivologist's point of view. In: Baldini A, Caldora P. , eds. Perioperative Medical Management for Total Joint Arthroplasty: How to Control Hemostasis, Pain and Infection. Switzerland: Springer International Publishing; 2015: 297-301
• 23 Ascione T, Balato G, Boccia G, De Caro F. Predictive value of fever following arthroplasty in diagnosing an early infection. Infez Med 2017; 25 (01) 3-7
• 24 Ascione T, Pagliano P, Balato G, Mariconda M, Rotondo R, Esposito S. Oral therapy, microbiological findings, and comorbidity influence the outcome of prosthetic joint infections undergoing 2-stage exchange. J Arthroplasty 2017;
• 25 Ascione T, Pagliano P, Mariconda M. , et al. Factors related to outcome of early and delayed prosthetic joint infections. J Infect 2015; 70 (01) 30-36