Arthrotomy versus arthroscopy in the treatment of septic arthritis of the knee in adults: a randomized clinical trial.

Purpose: To evaluate the efficacy of treatment and functional recovery of patients diagnosed with septic arthritis of the knee submitted to two surgical techniques: conventional arthrotomy and arthroscopic approach for debridement.

Method: In this prospective clinical study, all adult patients diagnosed with knee pyoarthritis in a 15-month period at a philanthropic hospital in Brazil were randomized into two groups: one group submitted to arthrotomy and the other to arthroscopy. The protocols of antibiotic therapy, physical therapy and postoperative assessment were standardized in both groups. Demographic, clinical, functional and laboratorial variables were compared between groups, with a minimum follow-up of 24 months.

Results: There was no difference in effectiveness of treatment in both groups, but 2 patients (18.2 %) of the arthrotomy group needed a new approach. The pain was higher in those undergoing treatment by arthrotomy, at 7 and 14 days postoperatively. The return to activities of daily living took an average of 5.7 days for both groups: 7.1 days for the arthrotomy group and 4.3 days for arthroscopy group.

Conclusion: It was found that the treatment of knee septic arthritis by both techniques showed similar effectiveness in healing, but the arthroscopy procedure was better than arthrotomy because it has a lower reinfection rate and low initial inflammatory reaction.

Level Of Evidence: Therapeutic studies, Level I.