RESUMO
PURPOSE@#Dabigatran is usually prescribed in recommended doses without monitoring of the blood coagulation for the prevention of venous thromboembolism after joint arthroplasty. ABCB1 is a key gene in the metabolism of dabigatran etexilate. Its allele variants are likely to play a pivotal role in the occurrence of hemorrhagic complications.@*METHODS@#The prospective study included 127 patients with primary knee osteoarthritis undergoing total knee arthroplasty. Patients with anemia and coagulation disorders, elevated transaminase and creatinine levels as well as already receiving anticoagulant and antiplatelet therapy were excluded from the study. The association of ABCB1 gene polymorphisms rs1128503, rs2032582, rs4148738 with anemia as the outcome of dabigatran therapy was evaluated by single-nucleotide polymorphism analysis with a real-time polymerase chain reaction assay and laboratory blood tests. The beta regression model was used to predict the effect of polymorphisms on the studied laboratory markers. The probability of the type 1 error (p) was less than 0.05 was considered statistically significant. BenjaminiHochberg was used to correct for significance levels in multiple hypothesis tests. All calculations were performed using Rprogramming language v3.6.3.@*RESULTS@#For all polymorphisms there was no association with the level of platelets, protein, creatinine, alanine transaminase, prothrombin, international normalized ratio, activated partial thromboplastin time and fibrinogen. Carriers of rs1128503 (TT) had a significant decrease of hematocrit (p = 0.001), red blood count and hemoglobin (p = 0.015) while receiving dabigatran therapy during the postoperative period compared to the CC, CT. Carriers of rs2032582 (TT) had a significant decrease of hematocrit (p = 0.001), red blood count and hemoglobin (p = 0.006) while receiving dabigatran therapy during the postoperative period compared to the GG, GT phenotypes. These differences were not observed in carriers of rs4148738.@*CONCLUSION@#It might be necessary to reconsider thromboprophylaxis with dabigatran in carriers of rs1128503 (TT) or rs2032582 (TT) polymorphisms in favor of other new oral anticoagulants. The long-term implication of these findings would be the reduction of bleeding complications after total joint arthroplasty.
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Humanos , Anemia/prevenção & controle , Anticoagulantes/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Subfamília B de Transportador de Cassetes de Ligação de ATP/metabolismo , Creatinina , Dabigatrana/uso terapêutico , Hemoglobinas , Polimorfismo Genético , Estudos Prospectivos , Tromboembolia Venosa/prevenção & controleRESUMO
INTRODUCTION@#The use of periarticular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) TXA have not been well explored in the literature. This retrospective cohort study aimed to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate postoperative pain relief and functional outcomes in patients after unilateral primary total knee arthroplasty (TKA).@*METHODS@#A total of 63 patients underwent TKA, and they were divided into the IA TXA delivery group ( n = 42) and PA TXA delivery group ( n = 21). All patients were administered 1 g of TXA. They also received pericapsular infiltration consisting of 0.5 mL of adrenaline, 0.4 mL of morphine, 1 g of vancomycin, 1 mL of ketorolac and 15 mL of ropivacaine. Outcomes for blood loss and surrogate markers for immediate functional recovery were measured.@*RESULTS@#Of the 63 patients, 54% were female and 46% male. The mean drop in postoperative haemoglobin levels in the PA and IA groups was 2.0 g/dL and 1.6 g/dL, respectively, and this was not statistically significant ( P = 0.10). The mean haematocrit drop in the PA and IA groups was 6.1% and 5.3%, respectively, and this was also not statistically significant ( P = 0.58). The postoperative day (POD) 1 and discharge day flexion angles, POD 1 and POD 2 visual analogue scale (VAS) scores, gait distance on discharge and length of hospitalisation stay were largely similar in the two groups.@*CONCLUSION@#Our study showed that both IA and PA TXA with analgesic components were equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.
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Humanos , Masculino , Feminino , Ácido Tranexâmico/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Antifibrinolíticos/efeitos adversos , Estudos Retrospectivos , Hemorragia Pós-Operatória , Perda Sanguínea Cirúrgica/prevenção & controle , Administração Intravenosa , Analgesia , Analgésicos/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Injeções Intra-ArticularesRESUMO
OBJECTIVE@#To evaluate the effect of wrist-ankle acupuncture (WAA) in pain and functional recovery after total knee arthroplasty (TKA).@*METHODS@#From June to September 2020, 94 participants were included from the Second Hospital of Tangshan and randomly assigned to the WAA group (47 cases) and the sham WAA group (47 cases) by a random number table, receiving real or sham WAA treatment, respectively. The primary outcome measure involved the visual analogue scale (VAS) scores at rest and in motion. The secondary outcomes involved the range of motion (ROM) of the knee joints, straight-leg raising time, postoperative weight-bearing time, sufentanil consumption within 48 h of patient-controlled analgesia (PCA) pump, length of hospital stay, and postoperative complications.@*RESULTS@#The VAS scores on the 3rd, 5th, and 7th postoperative days at rest and in motion was significantly lower in the WAA group than that of the sham WAA group (P<0.01). The ROM on the 1st, 2nd, and 3rd PODs was significantly higher in the WAA group than that of the sham WAA group (P<0.01). In comparison to the sham WAA group, the sufentanil consumption within 48 h of PCA pump was significantly less in the WAA group (156.3 ± 12.2 µg vs. 128.8 ± 9.8 µg, P<0.01). There was no significant difference in active straight-leg raising time, postoperative weight-bearing time, length of hospital stay, and postoperative complications between the two groups (P>0.05).@*CONCLUSIONS@#WAA could alleviate post-TKA pain, improve knee joint function, and reduce the sufentanil consumption within 48 h of PCA pump. WAA is a safe and effective treatment in the perioperative analgesic management for TKA.
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Humanos , Artroplastia do Joelho/efeitos adversos , Tornozelo , Punho , Sufentanil , Dor Pós-Operatória/terapia , Terapia por Acupuntura/efeitos adversos , Analgesia , Articulação do JoelhoRESUMO
OBJECTIVE@#To summarize the research progress of anterior cutaneous nerve injury and repair in knee arthroplasty.@*METHODS@#The relevant literature at home and abroad in recent years was reviewed and summarized from the anatomy of anterior cutaneous nerve, nerve injury grade, clinical manifestations, prevention and treatment of anterior cutaneous nerve.@*RESULTS@#The anterior cutaneous nerve injury is a common complication of knee arthroplasty. Because the anterior cutaneous nerve branches are many and thin, and mainly run between the first and second layers of fascia, this level is often ignored during surgical exposure. In addition, the knee arthroplasty does not routinely perform the exploration and repair of the cutaneous nerve. So the anterior cutaneous nerve injury is difficult to avoid, and can lead to postoperative skin numbness and knee pain. At present, studies have explored the feasibility of preventing its occurrence from the aspects of improved incision and intraoperative separation of protective nerve. There is no effective prevention and treatment measures for this complication. For patients with skin numbness after knee arthroplasty, the effectiveness of drug treatment is not clear. Local nerve block or nerve excision can be used to treat patients with painful symptoms after knee arthroplasty considering cutaneous pseudoneuroma.@*CONCLUSION@#Knee arthroplasty is widely used and anterior cutaneous nerve injury is common in clinic. In the future, more high-quality clinical studies are needed to further explore the prevention and treatment measures of this complication and evaluate the clinical benefits obtained.
Assuntos
Humanos , Artroplastia do Joelho/efeitos adversos , Hipestesia/etiologia , Pele , Dor/etiologia , Articulação do Joelho , Dor Pós-OperatóriaRESUMO
Introduction: Periprosthetic infection (PPI) is one of the most devastating complications of total knee arthroplasty (TKA). The incidence described in the literature is 2.4% and the most frequently isolated bacteria are Staphylococcus Aureus and Staphylococcus Coagulase-Negative (Gram positive). Polymicrobial infections represent between 10 to 37% and negative cultures between 7 to 15%. Methodology: Descriptive and retrospective study that consisted of reviewing the TKA database of the Regional Hospital of Talca during the 2018-2020 period, where knee PPIs were identified according to the diagnostic criteria validated in 2018. The cultures of patients diagnosed with PPI were reviewed, analyzing the antibiogram and resistance profile. Results: During 2018-2020, 459 TKAs were performed in our center, diagnosing 30 PPIs of the knee. 47% of PPIs were acute and 53% chronic. The results of the cultures were negative in 26.6%, 23.3% Methicillin Sensitive Staphylococcus Aureus; 13.3% Methicillin Resistant Staphylococcus Epidermidis and 13.3% of the cultures were polymicrobial. Discussion: Highlights the high resistance to methicillin, especially of Staphylococcus Epidermidis. This opportunistic pathogen has the ability to form a biofilm and, thanks to its genomic flexibility, rapidly acquires resistance to antibiotics. Polymicrobial infections have a synergistic effect that favors the persistence of the infection, which is why they will require a greater number of surgeries and prolonged antibiotic therapy. Pruebas especiales como la sonicación podrían aumentar las posibilidad de identificar al microorganismo. Conclusion: In these three years of follow-up, the PPI rate has been higher than reported annually in the literature. Gram-positive microorganisms continue to predominate, but with an increase in the rate of resistant to methicillin. Also, highlight the number of negative cultures. There would be a possible benefit theoretical in optimizing antibiotic prophylaxis in view of the large percentage of methicillin resistance and in seeking new ways to reduce negative cultures.
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Humanos , Feminino , Idoso , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/epidemiologia , Artroplastia do Joelho/efeitos adversos , Staphylococcus aureus , Estudos Retrospectivos , Biofilmes , AntibacterianosRESUMO
INTRODUCCIÓN La infección periprotésica (IPP) es una de las complicaciones más serias en una artroplastia total de rodilla (ATR). Pese a esto, existe poca literatura chilena respecto de esta patología. OBJETIVOS Determinar la incidencia, las comorbilidades, los microorganismos aislados y su susceptibilidad antibiótica, y la morbimortalidad en pacientes con IPP. MATERIALES Y MÉTODOS Estudio descriptivo y retrospectivo en pacientes operados entre 2001 y 2020 por gonartrosis, con una ATR primaria, en un mismo centro de salud, con al menos 1 año de seguimiento. Se excluyeron pacientes operados en otros centros o con registros clínicos incompletos. Se registraron las comorbilidades, los microorganismos aislados, la susceptibilidad antibiótica, y la sobrevida por medio de una búsqueda sistemática de las fichas clínicas de los pacientes con IPP. Se utilizó estadística descriptiva para presentar los datos. RESULTADOS Se incluyeron 544 ATRs, de las cuales 8 (1,47%) presentaron IPP, y los pacientes tenían una edad promedio de presentación de 66 (±5,7) años, e índice de masa corporal (IMC) promedio de 30,3 (±4,5) kg/m2. La mediana de tiempo de presentación de la IPP fue de 411 (±1.034) días. Las principales comorbilidades registradas fueron hipertensión arterial en 5 (62,5%), tabaquismo en 4 (50%) casos, y dislipidemia in 4 (50%) casos. En total, 5 (62,5%) pacientes presentaron etiología polimicrobiana, y en 3 (37,5%) se aisló un solo microorganismo. Los principales agentes aislados fueron Staphylococcus aureus y Staphylococcus coagulasa negativo, ambos multirresistentes, en 6 (75%) y 3 (37,5%) pacientes respectivamente. Todos los pacientes recibieron tres dosis de cefazolina como profilaxis quirúrgica. Se describe una sensibilidad del 100% frente a vancomicina y rifampicina (12/12 cultivos), y una resistencia del 83,4% al ciprofloxacino (4/9 cultivos). Un total de 2 (25%) pacientes fallecieron después de 3 años de la ATR por causas no relacionadas con la IPP. No hubo casos de recidiva infecciosa tras la revisión. CONCLUSIÓN Se encontró una incidencia de 1,47% (8 casos) de IPP. Todos los pacientes con IPP presentaron alguna comorbilidad prequirúrgica. Los principales agentes microbiológicos identificados fueron multirresistentes y susceptibles a vancomicina y rifampicina.
INTRODUCTION Periprosthetic infection (PPI) is one of the most serious complications in total knee arthroplasty (TKA). Despite this, there is little Chilean literature regarding this pathology. OBJETIVES To determine the incidence, comorbidities, isolated microorganisms and their antibiotic susceptibility, morbidity, and mortality in patients with PPI. MATERIALS AND METHODS A descriptive and retrospective study in patients operated between 2001 and 2020 for gonarthrosis, with a primary TKA, in the same health center, with at least 1 year of follow-up. Patients operated on in other centers or with incomplete clinical records were excluded. Comorbidities, isolated microorganisms, antibiotic susceptibility, and survival were recorded through a systematic search of the clinical records of patients with PPI. Descriptive statistics were used to present the data. RESULTS We included 544 TKAs, 8 (1.47%) of which presented PPI, and the patients had an average age at presentation of 66 years ( 5.7 years) and an average body mass index (BMI) of 30.3 ( 4, 5) kg/m2 . The median time of presentation of the PPI was of 411 ( 1,034) days. The main comorbidities recorded were arterial hypertension in 5 (62.5%), smoking in 4 (50%) cases, and dyslipidemia in 4 (50%) cases. In total, 5 (62.5%) patients presented polymicrobial etiology, and in 3 (37.5%), a single microorganism was isolated. The main isolated agents were Staphylococcus aureus and coagulasenegative Staphylococcus, both multidrug-resistant, in 6 (75%) and 3 (37.5%) patients respectively. All patients received three doses of cefazolin as surgical prophylaxis. A sensitivity of 100% to vancomycin and rifampicin (12/12 cultures), and a resistance of 83.4% to ciprofloxacin (4/9 cultures) were described. Overall, 2 (25%) patients died 3 years after the TKA, due to causes unrelated to PPI. There were no cases of infectious relapse after the review. CONCLUSION An incidence of 1.47% (8 cases) of PPI was found. All patients with PPI presented some presurgical comorbidity. The main microbiological agents identified were multidrug-resistant and susceptible to vancomycin and rifampicin
Assuntos
Humanos , Masculino , Feminino , Tabagismo/epidemiologia , Infecções Relacionadas à Prótese/epidemiologia , Artroplastia do Joelho/efeitos adversos , Diabetes Mellitus/epidemiologia , Hipertensão/epidemiologia , Staphylococcus aureus/isolamento & purificação , Comorbidade , Cefazolina/uso terapêutico , Chile/epidemiologia , Epidemiologia Descritiva , Incidência , Infecções Relacionadas à Prótese/tratamento farmacológico , Antibacterianos/uso terapêuticoRESUMO
OBJECTIVE@#To observe preventive effect of Caprini based thrombosis risk evaluation model on venous thromboembolism (VTE) after total knee replacement (TKA).@*METHODS@#Totally 257 TKA patients were admitted from May 2017 to December 2021 were selected. They were divided into conventional intervention strategies (121 patients in control group) and intervention strategies based on Caprini thrombosis risk evaluation model (136 patients in observation group), based on whether Caprini thrombosis risk evaluation model was introduced in May 2019. In normal gourp, there were 79 males and 42 females aged from 50 to 78 years old with an average of (63.10±11.86) years old;body mass index (BMI) ranged from 19 to 32 with an average of (25.21±4.95) kg/m2;55 patients on the left side and 66 on the right side. In observation group, there were 81 males and 55 females aged from 50 to 78 years old with an average of (64.35±10.54) years old;BMI ranged from 19 to 32 with an average of (24.43±5.18) kg/m2;87 patients on the left side and 49 on the right side. The incidence of VTE, visual analogue scale (VAS), Hospital for Special Surgery (HSS) score, affected limb swelling, mean velocity(Vm), peak velocity (PV), D-dimer (D-D), prothrombin time(PT), and incidence of complications were analyzed and compared.@*RESULTS@#The incidence of VTE in observation group was 1.47%(2/136), and 9.09%(11/121) in control group, and there was statistically difference between two groups (χ2=6.976, P=0.008). At 7 days after operation, VAS, HSS score and the difference in circumference of the affected limb in observation group were significantly better than those in control group, and had statistically differences (P<0.05). Blood flow Vm and PV levels between two groups were significantly increased (P<0.001), and blood flow Vm and PV levels in observation group were significantly higher than those in control group on the 7th day after operation, and had differences (P<0.001). The serum D-D level in observation group was significantly lower than that of in control group on the 7th day after operation, and PT level was significantly higher than that of in control group, and had difference(P<0.05). There was no difference in total incidence of complications between two groups (χ2=4.488, P=0.034).@*CONCLUSION@#Intervention strategy based on caprini thrombus risk evluation model could effectively reduce incidence of VTE and complications in TKA patients, improve swelling, hemodynamics and coagulation function of the affected limbs, and contribute to recovery of knee joint function.
Assuntos
Masculino , Feminino , Humanos , Pessoa de Meia-Idade , Idoso , Artroplastia do Joelho/efeitos adversos , Tromboembolia Venosa/prevenção & controle , Trombose/complicações , Hospitalização , Incidência , Estudos Retrospectivos , Fatores de RiscoRESUMO
BACKGROUND@#Patients commonly develop postoperative pain after total knee arthroplasty (TKA). Acupuncture-related techniques and low-level laser therapy could be beneficial for pain management for older individuals.@*OBJECTIVE@#To examine the effect of low-level laser acupuncture (LA) in reducing postoperative pain, pain-related interference in daily life, morphine consumption, and morphine-related side effects in older patients with knee osteoarthritis who underwent TKA.@*DESIGN, SETTING, PARTICIPANTS AND INTERVENTION@#A single-blind randomized placebo-controlled trial was conducted. Patients (N = 82) were recruited and randomly assigned via a computer-generated list to the LA group or a placebo group. The LA group received low-level laser therapy at Sanyinjiao (SP6), Taixi (KI3), Kunlun (BL60), Fengshi (GB31), Futu (ST32) and Neiguan (PC6) after TKA, while the placebo acupuncture group received the same treatment procedure without laser energy output.@*MAIN OUTCOME MEASURES@#The primary outcome was postoperative pain intensity, and it was measured at baseline and hours 2, 6, 10, 24, 48 and 72 after TKA. The secondary outcomes, including relative pain, postoperative pain-related interference in daily life and morphine consumption, were measured at hours 24, 48 and 72 after TKA.@*RESULTS@#Generalized estimating equations revealed significant between-group differences in pain intensity (P = 0.01), and trend differences in pain intensity for the LA group starting at hours 10 to 72 (P < 0.05) and morphine consumption at hours 48 and 72 (P < 0.05). The changes in pain-related interference in daily life were significant (P < 0.05) at 72 h, with the exception of the parameters for worst pain, mood, and sleep. Nausea and vomiting side effects from morphine had significant between-group differences at hours 10 and 24 (P < 0.05).@*CONCLUSION@#Low-level LA gradually reduced older patients' postoperative pain intensity and morphine consumption within the first 72 h after their TKA for osteoarthritis. Low-level LA may have benefits as an adjuvant pain management technique for clinical care.@*TRIAL REGISTRATION@#ClinicalTrials.gov registration number NCT03995446.
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Idoso , Humanos , Terapia por Acupuntura , Analgésicos Opioides/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Método Duplo-Cego , Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Método Simples-CegoRESUMO
OBJECTIVE@#To investigate the effect of tibial coronal curvature on the alignment of tibial prosthesis in patients undergoing total knee arthroplasty (TKA).@*METHODS@#From July 2019 to April 2021, 100 patients with knee osteoarthritis were treated with total knee arthroplasty. Before operation, the full-length films of lower limbs were taken and the tibial bowing angle(TBA) was measured. TBA more than 2° was tibial bending, which was divided into tibial bending group and non bending group. There were 40 cases in tibial bending group, 9 males and 31 females, aged 56 to 84 years old with an average of (69.22±7.10) years. There were 60 cases in the non bending group, 19 males and 41 females, aged from 51 to 87 years old with an average of (70.80±7.21) years. The preoperative tibial length (TL) and medial proximal tibial angle (MPTA) were measured and compared between the two groups. The full-length X-rays of the lower limbs were taken again 3 days to 1 week after operation. The medial angle of the tibial component coronal aligement angle (TCCA) and the outilier rate of force line of the tibial prosthesis were measured and compared between the two groups. Pearson method was used to analyze the correlation between TCCA and age, TCCA and height, TCCA and weight, TCCA and BMI, TCCA and TBA, TCCA and TL, TCCA and MPTA; Spearman method was used to analyze the correlation between TCCA and gender, TCCA and Kellgren-Lawrence(K-L) grade.@*RESULTS@#All 100 patients successfully completed the operation and obtained satisfactory full-length X-rays in standing position. There was no significant difference in TL, MPTA and TCCA between bending group and non bending group(P>0.05). The outilier rate of force line in tibial bending group was 22.5%, and that in non bending group was 6.67%, the difference was statistically significant(P<0.05). The correlation study found that TCCA was strongly correlated with TBA(r=-0.702, P<0.01), weakly correlated with MPTA(r=0.311, P<0.01), and had no correlation with other parameters(P>0.05).@*CONCLUSION@#In patients with knee osteoarthritis undergoing total knee arthroplasty, tibial bending will lead to poor force line of tibial prosthesis. During operation, attention should be paid to osteotomy of proximal tibial vertical tibial mechanical axis and correct installation of prosthesis to avoid poor alignment of prosthesis.
Assuntos
Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Tíbia/cirurgiaRESUMO
OBJECTIVE@#To investigate the effectiveness of modified Caprini risk assessment model(Caprini MRAM) in predicting the risk of deep venous thrombosis (DVT) after total knee arthroplasty (TKA).@*METHODS@#A case-control study was used to collect 43 patients with DVT after TKA in lower limb department of Sichuan Orthopedic Hospital from January 2016 to November 2020 in the positive group, and 172 patients without DVT after TKA in the same period according to the 1∶4 ratio between positive and control group were selected in the control group. Caprini MRAM was used to score and grade the risk of DVT. The clinical data, score and risk classification of the two groups were compared. The relationship between the risk of DVT in the patients after TKA and the risk factors in the risk ckassification and assessment of Caprini MRAM was analyzed by multivariate logistic regression model.@*RESULTS@#The average score of caprini in DVT group was significantly higher than that in control group[(8.11±2.91) vs(4.07±2.12), P<0.001];DVT group was mainly at medium and high risk group(66.67%), while the control group was mainly at low risk (77.33%). There was a significant difference between the two groups in risk classification composition (P<0.001). BMI≥30 kg/m2, lower extremity edema (<1 month), severe pulmonary disease (<1 month), acute myocardial infarction (<1 month), bed rest (> 2 h), history of superficial or deep vein or pulmonary embolism and family history of thrombosis were the main risk factors for DVT in patients after TKA(all P<0.05). Preoperative D-dimer elevation (OR=4.380), BMI≥30 kg/m2(OR=2.518), lower extremity edema(<1 month)(OR=7.652), acute myocardial infarction (<1 month) (OR=1.994), bed rest (> 72 h)(OR=3.897), history of superficial or deep vein or pulmonary embolism (OR=13.517) and family history of blood embolism (OR=6.551) were independent risk factors for DVT in patients after TKA (all P<0.05). The risk of DVT was 13.457 and 2.739 times higher in high and moderate risk TKA patients with Caprini MRAM classification, respectively.@*CONCLUSION@#Caprini MRAM can be used to predict the risk of DVT in patients after TKA, especially for patients with high risk.
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Humanos , Artroplastia do Joelho/efeitos adversos , Estudos de Casos e Controles , Medição de Risco , Fatores de Risco , Trombose Venosa/etiologiaRESUMO
Periprosthetic joint infection (PJI) is the most difficult complication following total joint arthroplasty. Most of the etiological strains, accounting for over 98% of PJI, are bacterial species, with Staphylococcusaureus and Coagulase-negative staphylococci present in between 50% and 60% of all PJIs. Fungi, though rare, can also cause PJI in 1%-2% of cases and can be challenging to manage. The management of this uncommon but complex condition is challenging due to the absence of a consistent algorithm. Diagnosis of fungal PJI is difficult as isolation of the organisms by traditional culture may take a long time, and some of the culture-negative PJI can be caused by fungal organisms. In recent years, the introduction of next-generation sequencing has provided opportunity for isolation of the infective organisms in culture-negative PJI cases. The suggested treatment is based on consensus and includes operative and non-operative measures. Two-stage revision surgery is the most reliable surgical option for chronic PJI caused by fungi. Pharmacological therapy with antifungal agents is required for a long period of time with antibiotics and included to cover superinfections with bacterial species. The aim of this review article is to report the most up-to-date information on the diagnosis and treatment of fungal PJI with the intention of providing clear guidance to clinicians, researchers and surgeons.
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Humanos , Artrite Infecciosa/etiologia , Artroplastia do Joelho/efeitos adversos , Fungos , Infecções Relacionadas à Prótese/terapia , Estudos RetrospectivosRESUMO
Osteoarthrosis of the knee is one of the most important causes of disability around the world, being total knee arthroplasty (TKA) a cost-effective surgical procedure for treating its severe stage when all knee compartments are compromised. Despite the good functional results and good survival of the implants and of the patients, still, 15 to 20% of the patients are dissatisfied after surgery. One of the causes of dissatisfaction is persistent pain located in the anterior part of the knee, which leads to controversy over whether to perform the patellar replacement. Advantages and complications are described in both scenarios, and neither is superior to the other in pain and implant survival. In the case of TKA without patellar replacement, the position of the femoral component plays a crucial role in achieving normal patellar tracking. The current challenge is to determine those clinical and radiological variables that allow us to predict the absence of long-term anterior pain in patients who require TKA and who do not undergo patellar replacement. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Dor Pós-Operatória/complicações , Artroplastia do Joelho/efeitos adversos , Osteoartrite do Joelho/cirurgia , Complicações Pós-Operatórias , Artroplastia do Joelho/métodosRESUMO
La fractura del poste tibial luego de un reemplazo total de rodilla es una complicación poco frecuente e incapacitante. Presentamos a dos pacientes con fractura del poste tibial no traumática, que acudieron con dolor más inestabilidad en recurvatum, de forma repentina, después de reemplazos articulares con buen funcionamiento previo. El primer paciente se presentó a los 12 años del reemplazo total de rodilla primario y el segundo, a los 14 meses. Ambos tenían el mismo modelo de prótesis estabilizada a pos-terior. Los dos pacientes fueron sometidos a una revisión con prótesis abisagrada rotatoria (Endo-Model NR®, Waldemar Link, EEUU), sin recidiva de la deformidad. Nivel de Evidencia: IV
Tibial post fracture after posterior stabilized total knee replacement (TKR) is a uncommon and disabling complication. We report two cases of non-traumatic tibial post fracture, which presented with sudden pain and recurvatum instability in joint replacements with good previous function. For the first case, the presentation time was 12 years from the primary TKR, and for the second it was 14 months. Both presented the same model of a posterior stabilized prosthesis. In both cases, a revision TKR was performed witha rotating hinge prosthesis (Endo-Model NR®, Waldemar Link), without recurrence of the deformity. Level of Evidence: IV
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Pessoa de Meia-Idade , Idoso , Fraturas da Tíbia , Artroplastia do Joelho/efeitos adversosRESUMO
OBJECTIVE@#To compare influence of retention or resection subpatellar fat pad on patella height during rheumatoid knee replacement.@*METHODS@#Totally 48 patients with rheumatoid arthritis who underwent total knee replacement from October 2013 to October 2017 were retrospectively analyzed and divided into resection and retention subpatellar fat pad group. There were 23 patients in resection subpatellar fat pad group, including 9 males and 14 females aged from 48 to 69 years old with an average of(55.83±5.65) years old; subpatellar fat pad were resected during opertaion. There were 25 patients in retention subpatellar fat pad group, including 6 males and 19 femlaes aged from 49 to 70 years old with an average age of (55.52± 6.28) years old;subpatellar fat pad were retentedduring opertaion. Postopertaive complications were observed between two groups, visual analogue scale (VAS) and Hospital for Special Surgery (HSS) at 1 year after operation were used to evaluate relieve pain degree and clnical effect of knee joint, Insall-Salvati ratio(I-S ratio) was used to compare changes of postoperative patella height at 1 year after operation.@*RESULTS@#All patients were followed up from 12 to 39 months with an average of (23.85± 8.82) months. The postoperative wound healed well without infection complications and no prosthetic loosening or revision. Postoperative VAS score at 1 year between two groups was lower than that of before opertaion(@*CONCLUSION@#Resection or retention subpatellar fat pad in rheumatoid knee replacement have advantages of relieving postoperative pain and improving functional recovery, however, retention of infrapatellar fat pad is beneficial to restoration of patellar height.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tecido Adiposo , Artroplastia do Joelho/efeitos adversos , Articulação do Joelho/cirurgia , Patela/cirurgia , Estudos RetrospectivosRESUMO
OBJECTIVE@#To study the distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty, and to formulate prevention and treatment strategies for drug-resistant bacteria.@*METHODS@#The data of 146 cases of periprosthetic infection after primary hip and knee arthroplasty from 2010 to 2015 were collected, including 111 cases of periprosthetic infection after hip arthroplasty and 35 cases of periprosthetic infection after knee arthroplasty. The culture positive rate, pathogenic bacteria composition and drug resistance rate were counted over the years, and the change trend of pathogen distribution and drug resistance was analyzed.@*RESULTS@#One hundredand eight strains of pathogenic bacteria were detected in 146 cases, and the positive rate of culture was 73.97%. Gram positive bacteria accounted for 55.48%, Staphylococcus epidermidis and Staphylococcus aureus accounted for 25.34% and 15.07% respectively. Gram negative bacteria accounted for 13.01%, including Enterobacter cloacae, Pseudomonas aeruginosa and Escherichia coli. There were 4 cases of Mycobacterium tuberculosis infection and mixed infection. The results of culture over the years showed that the constituent ratio of Gram positive bacteria had an increasing trend, fluctuating from 39.13% to 76.47%. The results of drug sensitivity showed that the pathogens were highly resistant to β-lactams, quinolones, clindamycin and gentamicin, and the drug resistance rate was increasing, but it was still sensitive to rifampicin, nitrofurantoin, tigecycline, linezolid and vancomycin.@*CONCLUSION@#Gram positive bacteria are the main pathogens of periprosthetic infection, and the proportion is increasing gradually.The pathogens have high resistance to many kinds of antibiotics, and the resistance rate is still increasing. To strengthen the monitoring of the distribution and drug resistance of pathogenic bacteria is helpful to grasp its change trend and formulate targeted prevention and control strategies.
Assuntos
Antibacterianos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Resistência a Medicamentos , Farmacorresistência Bacteriana , Bactérias Gram-Positivas , Testes de Sensibilidade Microbiana , Estudos RetrospectivosRESUMO
OBJECTIVE@#To investigate the effect of intra-articular injection of tranexamic acid on blood loss and blood transfusion rate after minimally invasive unicompartmental knee arthroplasty.@*METHODS@#From January 2015 to September 2017, 90 patients underwent minimally invasive unicompartmental knee arthroplasty were divided into tranexamic acid group and control group, 45 cases in each group. In the tranexamic acid group, there were 22 males and 23 females, aged 62 to 69 (66.1±2.4) years;in the control group, 20 males and 25 females, aged 63 to 71(68.5±5.2) years. The amount of bleeding in the drainage ball at 48 hours after operation was recorded, and the blood transfusion rate and hematocrit level duringthe perioperative period were recorded. The factors influencing perioperative blood loss included gender, age and body mass index (BMI).@*RESULTS@#All patients were followed up for 12.5 to 28.3 (22.8±7.9) months. During the follow-up, the wounds of the two groups healed well, and no deep vein thrombosis and pulmonary embolism occurred. There was no significant difference in postoperative blood loss between the tranexamic acid group and the control group. The postoperative bleeding volume in the tranexamic acid group was (110.0±52.1) ml, and that in the control group was (123.0±64.5) ml (P=0.39). There was no blood transfusion in the two groups.@*CONCLUSION@#Intra articular injection of tranexamic acid can not significantly reduce the postoperative blood loss in patients with minimally invasive unicompartment.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemostáticos , Injeções Intra-Articulares , Hemorragia Pós-Operatória , Ácido TranexâmicoRESUMO
OBJECTIVE@#To investigate the effect of continuous adductor block on pain control after bilateral knee joint Ⅰ stage replacement.@*METHODS@#A retrospective analysis was made of the data of 24 patients with bilateral knee joint I stage replacement who were treated in our hospital from January 2018 to January 2019, and who underwent continuous adductor block analgesia. There were 6 males and 18 females, aged 60 to 72 (65.05±5.82) years old. The patients underwent continuous block of adductor canal with patient-controlled analgesia system. At 4, 6, 12, 24, 36 and 48 hours after operation, visual analogue score(VAS) of resting state and passive motion state was performed;the knee joint activity was followed up for 1 week, 1, 3 and 6 months after operation;the knee joint function was scored at 6 months after operation, using the knee joint scoring standard of American Special Surgery Hospital(HSS);adverse reactions and complications were recorded.@*RESULTS@#The VAS scores under resting state and passive motion state at each time point were less than 3 points in patients with continuous adductor block. The patients had better postoperative exercise of knee joint activity. The score of HSS was excellent in 20 cases, good in 2 cases, fair in 1 case and poor in 1 case. There were only 4 cases of nausea and vomiting, none of them had serious adverse reactions and complications such as bradycardia and deep vein thrombosis.@*CONCLUSION@#Continuous adductor block has a significant effect on pain control and less adverse reactions after bilateral knee jointⅠ -stage replacement.
Assuntos
Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artroplastia do Joelho/efeitos adversos , Bloqueio Nervoso , Manejo da Dor , Dor Pós-Operatória , Estudos RetrospectivosRESUMO
Intentar el tratamiento retentivo de material protésico ante heridas quirúrgicas infectadas por gérmenes resistentes es objeto de debate, especialmente cuando el agente causal es un Staphylococcus aureus resistente a meticilina (SARM). Una paciente diabética y con obesidad tipo I sufrió infección de la herida quirúrgica tras artroplastia de rodilla que no evolucionó bien con antibioterapia empírica y terapia hiperosmolar. Se planificó una reintervención que fue demorada por motivos extramédicos (falta de terapia de presión negativa para cubrir la herida postoperatoria, pues se preveía no poder realizar cierre primario). Mientras se conseguía este material, y tras obtener el consentimiento de la paciente, se iniciaron irrigaciones de la herida con sevoflurano tópico off-label, pues ese fármaco ha mostrado capacidad antimicrobiana. La evolución clínica fue excelente desde el inicio a pesar de que en el cultivo se aisló un SARM resistente a la antibioterapia empírica, por lo que se desestimó la reintervención y se continuó con sevoflurano tópico junto a la antibioterapia dirigida por antibiograma, lográndose la curación completa de la herida tras 6 semanas. Durante ese tiempo, la paciente no experimentó ningún efecto adverso atribuible al sevoflurano. El sevoflurano tópico aparece como una valiosa nueva opción terapéutica ante heridas postoperatorias infectadas, especialmente cuando los gérmenes causantes son resistentes a los antibióticos convencionales.
It is challenging to try a retentive treatment of prosthetic material superinfected by resistant microorganisms, especially when the causative agent is a methicillin-resistant Staphylococcus aureus (MRSA). A diabetic, obese female patient suffered from a postoperative wound infection after a knee arthroplasty. Initial treatment with antibiotics and hyperosmolar therapy failed and clinical evolution was no good. Surgery was scheduled, but it was delayed due to nonmedical reasons (lack of negative-pressure therapy to cover the wound since primary wound closure was anticipated to be very improbable to perform). While waiting for this therapy, off-label irrigations with topical sevoflurane were started after obtaining written consent, since this drug has exhibited antimicrobial properties. Clinical evolution turned out to be excellent since the very beginning, even though a MRSA resistant to the antibiotics empirically administered was isolated. Thus, surgery was discarded, and culture-guided antibiotic therapy was added to topical sevoflurane, which was followed by a complete healing of the wound after 6 weeks. Sevoflurane treatment was well tolerated as the patient reported no adverse effects. Therefore, treating postsurgical wounds with topical sevoflurane appears as a valuable new alternative, especially when infections are caused by microorganisms resistant to conventional antibiotics.
Assuntos
Humanos , Feminino , Idoso , Infecções Estafilocócicas/tratamento farmacológico , Infecção da Ferida Cirúrgica/tratamento farmacológico , Artroplastia do Joelho/efeitos adversos , Sevoflurano/administração & dosagem , Infecções Estafilocócicas/etiologia , Infecção da Ferida Cirúrgica/etiologia , Administração Tópica , Staphylococcus aureus Resistente à Meticilina , AntibacterianosRESUMO
SUMMARY A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.
RESUMO OBJETIVO A hipertensão pulmonar (HP) indica elevação progressiva da resistência vascular pulmonar, levando ao excesso de enchimento, elevação da pressão venosa, congestão em vários órgãos e edema no sistema venoso. Este estudo teve como objetivo investigar se a HP é um fator de risco para trombose venosa profunda (TVP) das extremidades inferiores após cirurgia de prótese de quadril e joelho. MÉTODOS Um total de 238 pacientes que receberam a substituição da articulação das extremidades inferiores em nosso departamento de ortopedia de janeiro de 2009 a junho de 2012 foi examinado por ecocardiograma e fluxo de imagem Doppler colorido (CDFI) dos membros inferiores. De acordo com a pressão arterial pulmonar (PAP), os pacientes foram divididos em grupo PAP normal (n=214) e grupo PH (n=24). Todos os pacientes foram reexaminados por CDFI durante os cuidados pós-operatórios. RESULTADOS Entre os 238 pacientes, 18 pacientes tiveram TVP nas extremidades inferiores após a operação. A taxa de incidência total de TVP foi de 7,56% (18/238). No grupo PH, 11 pacientes tiveram TVP (45,83%, 11/24), mas no grupo PAP normal, apenas sete pacientes tiveram TVP (3,27%, 7/214). A incidência de TVP foi significativamente menor no grupo PAP normal do que no grupo PH (P<0,01). Além disso, houve uma correlação positiva entre a PAP e a incidência de TVP. CONCLUSÃO A HP poderia ser um fator de alto risco para a ocorrência de TVP nas extremidades inferiores do paciente após cirurgias de substituição articular.
Assuntos
Humanos , Masculino , Feminino , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Trombose Venosa/etiologia , Hipertensão Pulmonar/complicações , Complicações Pós-Operatórias/etiologia , Valores de Referência , Ecocardiografia Doppler , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/diagnóstico por imagem , Período Pré-Operatório , Quadril/irrigação sanguínea , Hipertensão Pulmonar/diagnóstico por imagem , Joelho/irrigação sanguíneaRESUMO
ABSTRACT BACKGROUND: Both postoperative pain control and range of motion are important in total knee arthroplasty (TKA). However, in the literature, there is little comparison of peripheral nerve blocks and periarticular infiltration techniques using levobupivacaine. The aim of our study was to measure pain with visual analogue scale (VAS) and knee range of motion (ROM) between in patients undergoing adductor canal block (ACB) for TKA using levobupivacaine compared to periarticular levobupivacaine infiltration (PAI-L). DESIGN AND SETTING: Prospective randomized clinical trial in a university hospital. METHODS: Patients aged 40-85 years who underwent unilateral TKA were included; 39 were treated withperiarticular infiltration using 40 ml (0.125 mg) of levobupivacaine (PAI-L group); and 40 were treated with ACB using 20 ml of 0.25% levobupivacaine (ACB-L group). Postoperative pain scores at rest and during active physical therapy were assessed using a VAS, along with knee ROM in flexion and extension. In addition, 100-foot walking time results, total morphine consumption and time of first analgesia requirement were recorded postoperatively. RESULTS: VAS scores at rest and during active physical therapy and the total amount of morphine consumed were lower in the ACB-L group than in the PAI-L group (P < 0.05). In contrast, knee ROM in flexion and extension and 100-foot walking times were greater in the PAI-L group than in the ACB-L group (P < 0.05). CONCLUSION: ACB-L was superior to PAI-L regarding pain treatment after TKA; however, PAI-L was superior to ACB-L regarding postoperative ROM and walking ability. CLINICAL TRIAL REGISTRY: ACTRN-12618000438257.