ABSTRACT
BACKGROUND: The purpose of this study was to determine the degree of infection control and postoperative function for new articulating metal-on-cement spacer. METHODS: A retrospective study of 19 patients (20 cases), who underwent a two-stage revision arthroplasty using mobile cement prosthesis, were followed for a minimum of 2 years. This series consisted of 16 women and 3 men, having an overall mean age of 71 years. During the first stage of revision, the femoral implant and all the adherent cement was removed, after which it was autoclaved before replacement. The tibial component was removed and a doughy state, antibiotic-impregnated cement was inserted on the tibial side. To achieve joint congruency, intraoperative molding was performed by flexing and extending the knee joint. Each patient was evaluated clinically and radiologically. The clinical assessments included range of motion, and the patients were scored as per the Hospital for Special Surgery (HSS) and Knee Society (KS) criteria. RESULTS: The mean range of knee joint motion was 70degrees prior to the first stage operation and 72degrees prior to the second stage revision arthroplasty; following revision arthroplasty, it was 113degrees at the final follow-up. The mean HSS score and KS knee and function scores were 86, 82, and 54, respectively, at the final follow-up. The success rate in terms of infection eradication was 95% (19/20 knees). No patient experienced soft tissue contracture requiring a quadriceps snip. CONCLUSIONS: This novel technique provides excellent radiological and clinical outcomes. It offers a high surface area of antibiotic-impregnated cement, a good range of motion between first and second stage revision surgery for the treatment of chronic infection after total knee arthroplasty, and is of a reasonable cost.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/administration & dosage , Arthroplasty, Replacement, Knee/adverse effects , Bone Cements/therapeutic use , Prosthesis-Related Infections/surgery , Range of Motion, Articular/physiology , Reoperation/instrumentation , Retrospective Studies , Treatment OutcomeABSTRACT
La cirugía para reemplazo de la articulación de la cadera en casos como las secuelas por trastornos en el desarrollo, malformaciones congénitas o en caderas pequeñas de personas de baja talla, requiere de modelos de prótesis que se adapten a esta morfología ósea, que las prótesis convencionales no solucionan. El sistema de las prótesis convencionales no solucionan. El sistema de la prótesis autobloqueante de Müller con vástago recto cuenta con un modelo para este tipo de caderas, en este trabajo se muestran los resultados de 5 años empleando esta prótesis CDH, reportando que en el 85 por ciento fueron excelentes y buenos a mediano plazo
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Osteoarthritis, Hip/surgery , Osteoarthritis, Hip/etiology , Intraoperative Complications , Biomechanical Phenomena , Orthopedic Fixation Devices , Hip Dislocation, Congenital/surgery , Hip Prosthesis , Reoperation/instrumentation , Reoperation/methods , Bone Screws , Pelvis , Postoperative Complications , Acetabulum/surgeryABSTRACT
Se realizaron 200 artroplastías totales de la cadera en 180 pacientes, de marzo de 1990 a marzo de 1995 mediante prótesis isoelástica. Se seleccionó a aquellos pacientes candidatos a artroplastía total de la cadera que tuvieran una configuración de tipo cilíndrico del conducto medular femoral. Después de cinco años de seguimiento, el 90 por ciento de los casos mostró buenos resultados. Del 10 por ciento de malos resultados, un caso desarrolló infección que requirió retiro de la prótesis, otro tuvo aflojamiento y los restantes tuvieron luxación postoperatoria inmediata que se resolvió por medio de un segundo abordaje quirúrgico
Subject(s)
Humans , Male , Female , Arthroplasty/instrumentation , Titanium , Elasticity , Prosthesis Fitting/rehabilitation , Prosthesis Design/rehabilitation , Prosthesis Design , Hip Prosthesis/adverse effects , Hip Prosthesis/instrumentation , Hip Prosthesis/methods , Reoperation/instrumentation , Reoperation/rehabilitation , Bone ScrewsABSTRACT
Se presenta una técnica de laparostomía que consiste en colocar una malla multiperforada de polietileno de alta densidad entre las vísceras y la cara interna de la pared abdominal sin ningún tipo de fijación, suturando además dos mallas de fibra poliamídica a los bordes del peritoneo y aponeurosis tomados conjuntamente. Se cierra luego la brecha enhebrando una aguja de tejer en las mallas de fibra poliamídica. Diariamente se quita la aguja y se observa el contenido abdominal para lavar o drenar focos sépticos. Al reinsertar la aguja se procura una progresiva reducción del diámetro transversal de la herida. Se emplea el procedimiento en 25 casos. No hubo complicaciones imputables al método
Subject(s)
Humans , Adult , Middle Aged , Abdomen/surgery , Abdominal Muscles/surgery , Laparotomy , Surgical Mesh , Reoperation/standards , Laparotomy/instrumentation , Surgical Mesh/economics , Surgical Mesh/standards , Pancreatitis/complications , Pancreatitis/surgery , Peritoneal Lavage , Peritonitis/complications , Peritonitis/mortality , Peritonitis/surgery , Polyethylenes/therapeutic use , Reoperation/instrumentation , Reoperation/mortalityABSTRACT
Säo analisados 50 pacientes portadores de peritonite difusa grave tratados com abdome aberto (laparostomia) protegido com tela de filó, em associaçäo com reoperaçöes planejadas, com o objetivo de estudar o comportamento da tela como material de proteçäo da cavidade peritoneal e demonstrar a experiência regional com esta forma de tratamento. Säo analisados aspectos relativos à aplicaçäo desta opçäo cirúrgica, afecçöes causadoras, material de proteçäo, complicaçöes e mortalidade. Os resultados permitem afirmar a utilidade da tela de filó como material de proteçäo da cavidade peritoneal e o melhor resultado desta forma de tratamento quando empregado primariamente