Arthroscopic Management for Pyogenic Arthritis with Positive Culture in the Knee Joint

배양 검사로 증명된 화농성 슬관절염의 관절경적 치료

  • Baek, Seung-Hoon (Department of Orthopaedic Surgery, School of Medicine, Catholic University of Daegu) ;
  • Kim, Se Sik (Department of Orthopaedic Surgery, School of Medicine, Catholic University of Daegu)
  • 백승훈 (대구가톨릭대학교 의과대학 정형외과학교실) ;
  • 김세식 (대구가톨릭대학교 의과대학 정형외과학교실)
  • Received : 2012.07.03
  • Accepted : 2012.08.13
  • Published : 2012.08.31

Abstract

Purpose: The purpose of this study is investigation of clinical and functional outcomes in homogeneous group with positive culture after arthroscopic management for pyogenic knee arthritis and analysis of factors affecting those outcomes. Materials and Methods: Thirty-two patients with positive culture after arthroscopic management were included. Mean follow-up period was 41.6 months. Clinical evaluation included death related to infection, recurrence, time to normalize erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), duration of administration of intravenous antibiotics and readmission. Radiographic evaluation was performed according to Kellgren and Lawrence. The prevalence of total knee arthroplasty was investigated and functional evaluation included modified Lysholm, Tegner activity and Korean version of the Western Ontario and McMaster Universities (K-WOMAC) score. Results: Staphylococcus aureus was identified in 21 patients. Time to normalize ESR and CRP was 78.0 and 67.6 days, respectively. Two patients died while there were six recurrences and five readmissions. Rate of recurrence was significantly high in patients with chronic renal failure (P=0.034) and incidence of readmission was associated with higher radiographic grade of osteoarthritis and rate of reoperation (P=0.032 and P=0.006, respectively). At the final follow-up, radiographic grade worsened in 21 patients and was associated with those at first visit. Five arthroplasties were performed. Average modified Lysholm score, Tegner activity score and K-WOMAC score were 53.5, 2.7, 44.2 points, respectively. Conclusion: The severity of osteoarthritis on final radiographs was associated with those at first visit. Patients with higher grade of osteoarthritis at first visit showed higher incidence of readmission and those with chronic renal failure demonstrated higher chances of recurrence.