Tidal irrigation in septic arthritis of the knee: a potential alternative to surgical drainage.
OBJECTIVE
To evaluate the efficacy of tidal irrigation (TI: repeated distention and irrigation of joint with saline under local anesthesia through 14 gauge Vere's needle) as a method to effect drainage in septic arthritis of the knee.


METHODS
Eleven episodes of septic arthritis of the knee in 10 patients were approached with TI when drainage of purulent material could no longer be satisfactorily accomplished with repeated arthrocenteses. Clinical and synovial fluid (SF) data were systematically collected and analyzed.


RESULTS
Four out of 11 episodes resolved without resorting to further surgical drainage. Cases responding to TI involved significantly older patients with lower volume effusions at presentation. Cases not responding to TI more frequently involved gram negative infection (3/7 cases vs 0/4). Variables of SF obtained preceding and following the first TI predicted outcome, with 3/4 responding cases demonstrating both a drop in white blood cell count of > or = 25% and a decrement of > or = 50% in volume while none of the cases eventually requiring surgery responded in this fashion (p < 0.05).


CONCLUSIONS
TI can potentially supplant conventional surgical drainage in some cases of septic knee arthritis that do not respond to medical management.
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Division of Rheumatology, Rackham Arthritis Research Unit, University of Michigan Medical Center, Ann Arbor 48109-0358.
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000601:surgery* / Q000628:therapy*; D004322:Drainage / Q000379:methods / Q000592:standards*; D005260:Female; D006801:Humans; D007592:Joint Diseases / Q000382:microbiology / Q000628:therapy*; D007719:Knee Joint / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000188:drug therapy; D013290:Streptococcal Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents