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Abstract：
OBJECTIVE: Septic arthritis (SA) of the native knee joint is associated with significant morbidity. This review compared post-operative functional outcomes (patient-reported outcome measures (PROMs) and range of movement (ROM)) following arthroscopic washout (AW) and open washout (OW) amongst adult patients with SA of the native knee. The need for further operative intervention was also considered.
METHODS: Electronic databases of PubMed, MEDLINE, Embase, Cochrane, Web of Science and Scopus were searched between 16 February 2023 and 18 March 2023. Randomised controlled trials (RCTs) and comparative observational analytic studies comparing function (reflected in PROMs or ROM) at latest follow-up following AW and OW were included. A narrative summary was provided concerning post-operative PROMs. Pooled estimates for mean ROM and re-operation rates were conducted using the random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias assessment tool-2 for RCTs and the Risk of Bias in Non-Randomized Studies of Interventions tool for observational analytic studies.
RESULTS: Of 2580 retrieved citations, 7 articles (1 RCT and 6 cohort studies) met the inclusion criteria. Of these, five had some concerns/moderate risk of bias, and two had serious risk. There was a slight tendency for superior mean PROMs following AW compared with OW, but due to small effect sizes, this was unlikely clinically relevant. Additionally, the use of four different PROMs scales made direct comparisons impossible. AW was associated with superior ROM (mean difference 20.18° (95% CI 14.35, 26.02; p < 0.00001)), whilst there was a tendency for lower re-operation requirements following AW (OR 0.64, 95% CI 0.26, 1.57, p = 0.44).
CONCLUSIONS: AW was associated with equivalent to superior post-operative function and lower requirement for further intervention compared with OW. Results need to be interpreted cautiously, taking into consideration the methodological and clinical heterogeneity of the included studies.
BACKGROUND: PROSPERO 2022, CRD42022364062.
METHODS: Electronic databases of PubMed, MEDLINE, Embase, Cochrane, Web of Science and Scopus were searched between 16 February 2023 and 18 March 2023. Randomised controlled trials (RCTs) and comparative observational analytic studies comparing function (reflected in PROMs or ROM) at latest follow-up following AW and OW were included. A narrative summary was provided concerning post-operative PROMs. Pooled estimates for mean ROM and re-operation rates were conducted using the random-effects model. The risk of bias was assessed using the Cochrane risk-of-bias assessment tool-2 for RCTs and the Risk of Bias in Non-Randomized Studies of Interventions tool for observational analytic studies.
RESULTS: Of 2580 retrieved citations, 7 articles (1 RCT and 6 cohort studies) met the inclusion criteria. Of these, five had some concerns/moderate risk of bias, and two had serious risk. There was a slight tendency for superior mean PROMs following AW compared with OW, but due to small effect sizes, this was unlikely clinically relevant. Additionally, the use of four different PROMs scales made direct comparisons impossible. AW was associated with superior ROM (mean difference 20.18° (95% CI 14.35, 26.02; p < 0.00001)), whilst there was a tendency for lower re-operation requirements following AW (OR 0.64, 95% CI 0.26, 1.57, p = 0.44).
CONCLUSIONS: AW was associated with equivalent to superior post-operative function and lower requirement for further intervention compared with OW. Results need to be interpreted cautiously, taking into consideration the methodological and clinical heterogeneity of the included studies.
BACKGROUND: PROSPERO 2022, CRD42022364062.
摘要：
目的:天然膝关节的化脓性关节炎(SA)与显著的发病率相关。这篇综述比较了患有天然膝关节SA的成年患者在关节镜冲洗（AW）和开放式冲洗（OW）后的术后功能结果（患者报告的结果测量（PROM）和运动范围（ROM））。还考虑了进一步手术干预的必要性。
方法：PubMed的电子数据库，MEDLINE,Embase,科克伦,在2023年2月16日至2023年3月18日之间搜索了WebofScience和Scopus。包括在AW和OW后的最新随访中比较功能（反映在PROM或ROM中）的随机对照试验（RCT）和比较观察性分析研究。提供了有关术后PROM的叙述性总结。使用随机效应模型对平均ROM和再手术率进行了汇总估计。使用Cochrane偏倚风险评估工具-2评估RCT的偏倚风险和非随机干预研究工具中的偏倚风险进行观察性分析研究。
结果：在2580个检索到的引文中，7篇文献(1篇RCT和6篇队列研究)符合纳入标准。其中,五个人有一些担忧/适度的偏见风险，两个有严重的风险。与OW相比，AW后的平均PROM有轻微的趋势，但是由于效果大小小，这不太可能与临床相关.此外,使用四种不同的PROM量表无法进行直接比较。AW与高ROM相关（平均差异20.18°（95％CI14.35，26.02；p<0.00001）），而AW后的再手术需求有降低的趋势(OR0.64,95%CI0.26,1.57,p=0.44)。
结论：与OW相比，AW具有相当的术后功能，并且对进一步干预的要求较低。结果需要谨慎解释，考虑到纳入研究的方法学和临床异质性。
背景：PROSPERO2022，CRD42022364062。
方法：PubMed的电子数据库，MEDLINE,Embase,科克伦,在2023年2月16日至2023年3月18日之间搜索了WebofScience和Scopus。包括在AW和OW后的最新随访中比较功能（反映在PROM或ROM中）的随机对照试验（RCT）和比较观察性分析研究。提供了有关术后PROM的叙述性总结。使用随机效应模型对平均ROM和再手术率进行了汇总估计。使用Cochrane偏倚风险评估工具-2评估RCT的偏倚风险和非随机干预研究工具中的偏倚风险进行观察性分析研究。
结果：在2580个检索到的引文中，7篇文献(1篇RCT和6篇队列研究)符合纳入标准。其中,五个人有一些担忧/适度的偏见风险，两个有严重的风险。与OW相比，AW后的平均PROM有轻微的趋势，但是由于效果大小小，这不太可能与临床相关.此外,使用四种不同的PROM量表无法进行直接比较。AW与高ROM相关（平均差异20.18°（95％CI14.35，26.02；p<0.00001）），而AW后的再手术需求有降低的趋势(OR0.64,95%CI0.26,1.57,p=0.44)。
结论：与OW相比，AW具有相当的术后功能，并且对进一步干预的要求较低。结果需要谨慎解释，考虑到纳入研究的方法学和临床异质性。
背景：PROSPERO2022，CRD42022364062。
