Treatment of pyogenic Arthritis of the knee joint

ABSTRACT

17 pts. of different ages having acute pyogenic arthritis of 18 knees due to variabla causes have been treated. The treatment regimen adopted was arthrotomy, thorough lavage with continuous suction drainage for 3 days following surgery. Early knee flexion were encouraged under light skin traction with later two weeks of cast immobilization. In all 12 cases presenting within the 1st week the functional outcome was excellent. In the other 5 cases presenting later than the 1st week, partial synovectomy was added to the above treatment program, with satisfactory results in 4 of them. It is concluded that acute pyogenic arthritis of the knee is best treated by urgent arthrotomy, with additional synovectomy in cases seen later. Early knee flexion exercises proved to be a worth-while addition in the management of such cases. There is general agreement regarding the necessity for urgent surgical drainage of an infected joint. Although antibiotics have reduced the number of deaths and of complications of suppurative arthritis, yet a large number of patients do not retain a functional joint after treatment. There are however, several methods of joint drainage including repeated aspirations, closed suction drainage, arthortomy and open arthrotomy [Ballard et al., 1975]. As regards post operative management, opinions are controversial; whereas most authors agree that the infected joint has to be immobilized immediately after drainge, yet others do encourage early active motion. In the present work we studied the results of treament of pyogenic knee arthritis by arthrotomy with closed suction drainage and early active movements, with additional synovectomy in some cases