EVALUATION OF TREATMENT MODALITIES FOR SEPTIC ARTHRITIS WITH HISTOLOGICAL GRADING AND ANALYSIS OF LEVELS OF URONIC-ACID, NEUTRAL PROTEASE, AND INTERLEUKIN-1

We compared the effectiveness of antibiotics alone and in combination with arthroscopy, arthroscopy with debridement, arthrotomy, or needle aspiration for the treatment of septic arthritis. Each modality has it s proponents, but, to our knowledge, no comparative studies have been conducted in animals. We used biochemical and histological analysis to compare these methods of treatment in an experimental model. The righ t hind knee of thirty goats was injected with 1 x 10(5) Staphylococcus aureus bacilli. The left hind knee mas not inoculated and served as t he normal control. Seventy-two hours after inoculation, a two-week cou rse of treatment with intramuscular administration of cefuroxime sodiu m, either alone or in combination with another mode of treatment, was initiated in each of five groups. The cartilage was evaluated histolog ically with biochemical, enzymatic, and interleukin-1 analyses. Despit e the early therapeutic intervention, on the average, there was a 25 p er cent loss of uronic acid (t test, p < 0.001) and a 43 per cent incr ease in neutral protease activity (signed-rank test, p = 0.003) in the treatment groups. There were no significant intergroup differences wi th regard to the histochemical-histological rating or the levels of ur onic acid, neutral protease, or interleukin-1. CLINICAL RELEVANCE: The treatment of septic arthritis, excluding that in the hip joint, is ch anging, with an emphasis on less invasive operative techniques. In the present study, early treatment with an appropriate antibiotic and suc h treatment with arthrotomy, arthroscopy, arthroscopy with debridement , or needle aspiration produced indistinguishable results. Our finding s suggest that, if an infected knee joint is diagnosed early and appro priate antibiotic therapy is initiated immediately after the diagnosis , any of the standard treatment modalities can effectively eradicate t he infection, with minimum damage to the cartilage.