Surgical therapy of extensive knee joint empyema: mid-term results after two-stage versus one-stage procedures.
OBJECTIVE
Untreated knee joint empyema leads to rapid destruction of the joint and, thus far, has proven challenging to treat. This study presents data obtained after one- versus two-stage surgical approaches. Specifically, clinical outcome, complication rate, re-infection rate, duration of operation, and hospital stay are reported.


METHODS
Between 2006 and 2010, 67 patients with extensive knee joint empyema underwent surgical therapy. Patients underwent either a two-stage surgical approach with open joint treatment for 7-10 days or a one-stage procedure with primary closure of the knee joint after radical debridement.


RESULTS
The two-stage procedure was performed on 36 patients, whereas the one-stage procedure was performed on 31 patients. Infection duration prior to the index procedure ranged from 3 days to 55 months (two-stage: ~5 months, one-stage: ~2.4 months). The groups did not differ significantly in demographic group characteristics. Hospital stay and duration of operation were significantly (p < 0.01) reduced in the one-stage group compared to the two-stage group (31.1 ± 10.6 vs. 23.4 ± 14.4 days and 105 ± 32 vs. 68 ± 18 min, respectively). Functional outcome improved in both groups from the pre- to post-operative period, but did not differ significantly between groups.


CONCLUSIONS
The one-stage open surgical approach produced similar results to the two-stage approach in the treatment of extensive knee joint empyemas. However, by waiving the open joint treatment concept, duration of hospital stay and operation time could be significantly reduced.


METHODS
III.
Department of Orthopaedics and Trauma Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany, ralf.oheim@uksh.de.
Ralf
R
Oheim
Justus
J
Gille
Rita
R
Schoop
Sylvia
S
Badih
Cornelius H
CH
Grimme
Arndt-Peter
AP
Schulz
Christian
C
Jürgens
Ulf-Joachim
UJ
Gerlach
D003646:Debridement; D004653:Empyema / Q000382:microbiology / Q000601:surgery*; D005260:Female; D006801:Humans; D007719:Knee Joint / Q000382:microbiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies