Purpose
To compare the rates of reoperation and 90-day perioperative complications between
open arthrotomy and arthroscopy for the treatment of septic ankle arthritis using
a national all-payer claims database.
Methods
Patients with a diagnosis of septic ankle arthritis who underwent irrigation and debridement
through arthroscopy or arthrotomy were identified in a national data set from 2015-2020
through an all-payer claims database. Demographic and comorbidity characteristics
including age, sex, infectious etiologies, and Elixhauser comorbidities were obtained.
The rate of reoperation, defined as a proxy for failure of initial intervention, was
the primary outcome. Secondary outcomes including readmissions, surgical-site infections,
amputations, wound complications, and 90-day medical complications were compared between
the 2 cohorts.
Results
In total, 168 patients undergoing arthroscopy and 794 patients undergoing arthrotomy
for septic ankle arthritis were identified. There were no significant differences
in reoperation rates between patients who underwent open arthrotomy and those who
underwent arthroscopy (P = .997). However, the rates of surgical-site infection (P = .014) and hospital readmission (P < .001) were significantly higher in the open arthrotomy cohort compared with the
arthroscopy cohort.
Conclusions
Although there was no significant difference in reoperation rates between arthroscopic
and open irrigation and debridement for the treatment of septic ankle arthritis, this
study showed significantly higher odds of surgical-site infection and hospital readmission
in patients who underwent open arthrotomy when compared with arthroscopy. Case-specific
patient and technical considerations should guide the surgical decision-making process
to limit secondary complications because this study exemplifies similar reoperation
rates between the 2 surgical modalities.
Level of Evidence
Level III, nonrandomized cohort analysis.
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Article Info
Publication History
Published online: January 27, 2022
Accepted:
January 16,
2022
Received:
June 17,
2021
Footnotes
The authors report no conflicts of interest in the authorship and publication of this article. Full ICMJE author disclosure forms are available for this article online, as supplementary material.
Identification
Copyright
© 2022 by the Arthroscopy Association of North America
