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Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis

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Abstract

Purpose

To evaluate the efficacy of arthrotomy, when compared with arthroscopy, in the treatment of adults with septic arthritis of any joint.

Methods

MEDLINE, EMBASE, and Scopus were searched to identify studies comparing arthrotomy and arthroscopy as therapeutic approaches in patients with septic arthritis of any joint. The main outcome was the re-infection rate. A meta-analysis was performed using the generic inverse variance method with random or fixed effects model depending on heterogeneity between studies. Heterogeneity was tested with the I2 statistic index.

Results

Twenty studies with 10,249 patients treated by arthrotomy or arthroscopy were evaluated. We observed a significant lower risk of re-infection (odds ratio [OR], 1.35 [95% CI, 1.16–1.58]; p = 0.0002) and complications (OR, 1.32 [95% CI, 1.12–1.55]; p = 0.001) rate as well as less hospital stay (mean difference [MD], 0.57 days [95% CI, 0.10–1.05]; p = 0.02) favouring arthroscopic intervention. The subanalysis indicated that patients with knee (OR, 1.50 [95% CI, 1.17–1.92]; p = 0.001) and shoulder (OR, 1.24 [95% CI, 1.00–1.53]; p = 0.04) septic arthritis intervened by arthrotomy had a higher risk of re-infection. A lower number of hospitalization days (MD, 0.89 days [95% CI, 0.31–1.47]; p = 0.003) and a lower risk for complications (OR, 1.26 [95% CI, 1.04–1.52]; p = 0.02) were observed in patients treated with arthroscopy after septic knee arthritis.

Conclusions

Available evidence suggests that patients with septic arthritis of the knee and shoulder treated by arthroscopy have less risk of re-infection than those treated by arthrotomy. The quality of the body of evidence is still insufficient to reach reliable conclusions.

PROSPERO trial registration number

CRD42020176044. Date registration: April 28, 2020.

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Data availability

All relevant data are reported within this manuscript, additional information will be available upon request to the corresponding author.

Code availability

Not Applicable.

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Authors and Affiliations

  1. Orhtopedics and Truamatology Service, University Hospital “Dr. José E. González”, Universidad Autonoma de Nuevo Leon, Fco. I. Madero and José Eleuterio González, 64460, Monterrey, México

    Carlos Acosta-Olivo, Félix Vilchez-Cavazos, Jaime Blázquez-Saldaña, Gregorio Villarreal-Villarreal, Victor Peña-Martínez & Mario Simental-Mendía

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Contributions

CAO conceptualized and designed the study, interpretation of data, drafted the initial manuscript, critically reviewed the manuscript, and approved the final version as submitted. VPM contributed to the conception, critically reviewed the manuscript, and approved the final version as submitted. JBS contributed to the concept and design of the study, drafted the initial manuscript, and approved the final version. FVC contributed to the conception, critically reviewed the manuscript, and approved the final version as submitted. GVV contributed to statistical analysis and interpretation of data, follow-up of the patients, drafted the initial manuscript, and approved the final version. MSM conceptualized and designed the study, carried out the statistical analysis and interpretation of data, drafted the initial manuscript, and approved the final version as submitted.

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Correspondence to Mario Simental-Mendía.

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Acosta-Olivo, C., Vilchez-Cavazos, F., Blázquez-Saldaña, J. et al. Comparison of open arthrotomy versus arthroscopic surgery for the treatment of septic arthritis in adults: a systematic review and meta-analysis. International Orthopaedics (SICOT) 45, 1947–1959 (2021). https://doi.org/10.1007/s00264-021-05056-8

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