385. Arthroscopic vs. Open Surgery for Septic Arthritis of the Knee: A Systematic Review and Meta-Analysis

BACKGROUND: Septic arthritis is a joint-threatening and life-threatening infection, with the knee representing the most frequently involved joint. There is no definitive treatment algorithm for the management of this condition, which typically includes surgical debridement to decompress the joint, followed by organism-specific intravenous antibiotics. METHODS: Search Methods. MEDLINE (1965–2018), SCOPUS (1973–2018), The COCHRANE Library (2006–2017), EMBASE (1974–2018), reference lists, and scientific meetings were searched for relevant studies on the treatment of native knee septic arthritis by three independent reviewers. No language restrictions were used. Selection criteria included all studies reporting on native knee septic arthritis in adults treated with arthroscopy and open arthrotomy with irrigation and debridement. Data Collection and Analysis Studies were identified, subjected to inclusion and exclusion criteria, and reviewed by three independent reviewers. Patient characteristics, interventions, and outcomes were extracted, and the trials were rated for quality based on established criteria. A meta-analysis was conducted for the primary outcome, reoperation occurring after arthroscopic vs. open arthrotomy irrigation and debridement for the treatment of septic arthritis. We used a qualitative analysis for secondary outcomes physical function and hospital length of stay. RESULTS: From 624 abstracts, eight trials met inclusion criteria, one randomized controlled trial and seven retrospective cohorts. Quantitative meta-analysis showed arthroscopic irrigation and debridement resulted in fewer reoperations compared with open arthrotomy (RR = 0.76; 95% CI 0.59–0.97, P = 0.03, I(2) = 24%), Figure 1. A qualitative summary of seven included studies assessing physical function showed arthroscopic debridement results in improved functional outcomes and range of motion compared with open arthrotomy. Based on four trials, qualitative summary demonstrated that arthroscopic debridement results in decreased hospital length of stay compared with open arthrotomy. CONCLUSION: Arthroscopic irrigation and debridement is favored over open arthrotomy with regard to lower rates of reoperation, improved functional outcomes, and shorter hospital length of stay. [Image: see text] DISCLOSURES: All authors: No reported disclosures.