INTRODUCTION: Septic arthritis poses significant challenges due to its potential for joint damage and life-threatening complications. The choice between arthroscopy and open arthrotomy as surgical approaches remains a critical decision in septic arthritis management. However, limited research has focused on patient-reported outcomes and quality of life following treatment. MATERIALS AND METHODS: A retrospective study was conducted at a German level 1 trauma center, including 58 adult septic arthritis patients treated with arthroscopy (n = 29) or open arthrotomy (n = 29). Quality of life was assessed using the EQ-5D instrument. Functional mobility was evaluated with the Parker Mobility Score, while the Katz Score assessed activities of daily living (ADL). The mean follow-up time was 5.6 years. RESULTS: Comparable EQ-5D VAS scores were observed in both groups, with no significant difference in the quality of life between arthroscopy and open arthrotomy patients (64.8 ± 19.3 vs. 64.7 ± 19.6, p = 0.749). Notably, both groups reported limitations in pain/discomfort and mobility, while the open arthrotomy group exhibited more anxiety/depression limitations (p = 0.024). Functional mobility, as assessed by the Parker Mobility Score (6.50 ± 2.62 vs. 6.51 ± 2.60, p = 0.617), and ADL independence, using the Katz Score (5.06 ± 1.72 vs. 5.05 ± 1.71, p = 0.181) remained similar between the two groups. CONCLUSION: In septic arthritis management, arthroscopy and open arthrotomy yield similar long-term QoL outcomes, functional mobility, and ADL independence. Despite these findings, it is crucial to interpret the results with caution, given potential limitations associated with retrospective studies, and external factors influencing long-term outcomes. Further prospective research, incorporating larger sample sizes and extended follow-up, is necessary to refine our understanding of septic arthritis management strategies and their impact on patient well-being. LEVEL OF EVIDENCE: III.