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

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.

Keywords: Arthroscopy; Arthrotomy; Knee; Septic arthritis; Shoulder.