Starch as a risk factor for increased trans surgical bleeding in total hip arthroplasty.

OBJECTIVE: Establish whether the use of starch in hip arthroplasty is a risk factor for excessive surgical bleeding and requirement of red blood cell transfusion. METHOD: Analytical observational retrospective study in 240 patients who underwent primary total hip arthroplasty from January 2015 to January 2016. Two groups were formed: starch (94 patients) and non-starch (146 patients). Age, sex, body mass index, preoperative and postoperative hemoglobin, red cell transfusion and surgical bleeding was analyzed. RESULTS: Starchy group had increased risk of excessive surgical bleeding (OR: 3.58; 95% CI: 2.05- 6.26) and red blood cells transfusion (OR: 3.12; 95% CI: 1.76 -5.5). In the starch group average surgical bleeding was 396 ml (SD: ± 234.94) and a decrease in hemoglobin of 4.6 g/dl (SD± 1.38). The control group had an average bleeding of 271.8 ml (SD: ± 139.22) and decrease in hemoglobin of 3.34 g/dl (SD: ± 1.4). DISCUSSION: The starch group had higher surgical bleeding and required more often red blood cells transfusion than the non-starch group. We suggest to take in account the possible complications related to the use hydroxyethyl starch.

OBJETIVO: Determinar si el uso de almidón en la artroplastia de cadera es un factor de riesgo para el sangrado transquirúrgico excesivo y el uso de concentrados eritrocitarios. MÉTODO: Estudio retrospectivo observacional analítico de 240 pacientes sometidos a artroplastia total de cadera primaria desde enero de 2015 hasta enero de 2016. Se integraron dos grupos: almidón (94 pacientes) y no almidón (146 pacientes). Se analizaron la edad, el sexo, el índice de masa corporal, la hemoglobina prequirúrgica y posquirúrgica, el uso de concentrados eritrocitarios y el sangrado transquirúrgico. RESULTADOS: El grupo con almidón tuvo mayor riesgo de sangrado transquirúrgico excesivo (odds ratio [OR]: 3.58; intervalo de confianza del 95% [IC 95%]: 2.05- 6.26) y de transfusión de concentrados eritrocitarios (OR: 3.12; IC 95%: 1.76-5.5). En el grupo con almidón hubo una media de sangrado transquirúrgico de 396 ml (desviación estándar [DE]: ± 234.94) y una disminución de la hemoglobina de 4.6 g/dl (DE: ± 1.38); en el grupo de no almidón hubo una media de sangrado de 271.8 ml (DE: ± 139.22) y una disminución de la hemoglobina de 3.34 g/dl (DE: ± 1.4). DISCUSIÓN: Los pacientes con almidón presentaron mayor sangrado transquirúrgico y requirieron en más ocasiones la transfusión de hemoderivados que los del grupo control, por lo que sugerimos considerar las posibles complicaciones relacionadas con el uso de hidroxietilalmidón.

A prospective randomized trial of total synovectomy versus limited synovectomy in primary total knee arthroplasty: evaluation of bleeding, postoperative pain, and quality of life with SF-12 v2.

BACKGROUND: During total knee arthroplasty (TKA), total synovectomy (TS) as a part of the surgical technique has been proposed to reduce the inflammatory tissue after the procedure, but there is a controversy about it because of the risk of major postsurgical bleeding. The aim of this study was to compare postoperative bleeding, pain, and health-related quality of life (HRQOL) after a TKA when a TS is performed and when it is not. METHODS: The difference in pre and postoperative hemoglobin was measured, as well as postoperative pain using visual analogue scale (VAS) scores at 24 and 48 h post-surgical, HRQOL was measured prior to surgery and at one year using the SF-12V2 questionnaire. RESULTS: We assessed a total of 148 patients (73 for TS and 75 for limited synovectomy). We have found a difference of 0.9 mg/dl of pre- and postoperative hemoglobin between both groups, with a higher bleeding amount for the TS group (P = 0.0000647); VAS scores were slightly lower for the TS group at 24 and 48 h after surgery, but not relevant. The TS group required transfusion in 13.3% and the limited synovectomy group in 6.8%. No significant differences in HRQOL were found in both groups at 1 year follow-up. CONCLUSIONS: Performing a TS in TKA in patients with osteoarthrosis does not result in a relevant lower postoperative pain, or in an improvement in HRQOL, and it does increase the amount of bleeding after the procedure.

Risk factors for amputation in periprosthetic knee infection.

Treatment for prosthetic knee replacement is becoming more common. Infection is an arthroplasty-related complication leading to prolonged hospitalization, multiple surgical procedures, permanent loss of the implant, impaired function, impaired quality of life and even amputation of the limb. Previous studies have evaluated the risk factors associated with periprosthetic knee infection, but scarce information related to risk factors associated with amputation in this group of patients is available. The purpose of this study was to identify risk factors for amputation in periprosthetic infected knee through a case-control study, analyzing patients treated from January 2012 to November 2016 in a hospital with a high incidence of this diagnosis. We included 183 patients with periprosthetic knee infection; 23 required amputation as definitive management (cases). We found that patients with surgical time >120 min (p = 0.01), surgical risk higher than two points according to the American Society of Anesthesiology score (p = 0.00), smokers (p = 0.04), obesity and diabetes mellitus (p = 0.00) had an increased risk of amputation.

Caracterizacion histopatologica y bacteriologica de las membranas periprotesicas de cadera

Criterios de Morawietz

[Mixed knee arthrodesis a rescue alternative in knee periprosthetic joint infection]. / Artrodesis mixta de rodilla: una alternativa de salvamento en infecciones periprotésicas de rodilla.

BACKGROUND: Knee arthrodesis is a rescue procedure for patients with knee periprosthetic joint infection who are not candidates for a revision surgery. The actual methods present a high complication rate with only moderate efectivity. METHODS: We retrospectively analyzed 17 cases, of patients with knee periprosthetic joint infection and bone loss treated by intramedular expandable nail and monoplanar external fixator with a mínimum evolution of 1 year, evaluating the medical records and digitalized X-rays by 2 sub specialized doctors in osteoarticular rescue surgery. RESULTS: From the 17 patients, 88.2% were classified as Anderson Orthopaedic Research Institute classification grade (III) and the 11.2% IIB. We obtained fusion in 82.5%, staged Hammer (I-II) in a mean time of 6.33 months. Achieving independent gait was reported in 88.2%. Our complication rate was 47.1%, most of them minor complications except for a supracondylar amputation. Our infection recurrence rate was 35.4%. Mean intervention rate was 2.47 surgeries, all without any operative room complication. CONCLUSIONS: We achieved a fusion rate similar to other available knee arthrodesis methods in a similar treatment time; with lower complication rate, making it a suitable rescue alternative for knee arthrodesis in patients with significant bone loss and knee periprosthetic joint infection.

Introducción: la artrodesis es una cirugía de salvamento para la infección periprotésica de rodilla; este procedimiento reporta moderada efectividad, alto índice de complicaciones y es la última alternativa antes de la amputación. El objetivo de este estudio fue identificar si la artrodesis de rodilla con clavo expandible y fijador externo es un tratamiento seguro y efectivo. Métodos: estudio observacional, retrospectivo, en 17 pacientes con infección periprotésica y pérdida ósea importante, tratados mediante artrodesis con clavo centro-medular expandible autobloqueante y fijador externo monoplanar con evolución mínima de 1 año; la información se obtuvo del expediente clínico e imágenes de rayos X, siendo estas evaluadas por 2 ortopedistas especializados en rescate osteoarticular. Resultados: de 17 pacientes, con una pérdida ósea grado III en un 88.2% de los casos, se obtuvo una fusión en el 82.5%. Logrando la deambulación independiente en el 88.2%. Con un promedio de 2.4 intervenciones quirúrgicas por paciente. Sin complicaciones transquirúrgicas reportadas. Con un índice de complicaciones global del 47.1% incluyendo una amputación por sepsis. La evaluación inter-observador tuvo un valor de Kappa del 0.90 y la muestra alcanzó un poder estadístico del 60%. Conclusiones: se obtuvo una consolidación similar a otros métodos, en un tiempo promedio de 6.3 meses, con un menor índice de complicaciones al reportado con otras técnicas. Siendo esta una alternativa de salvamento para la realización de artrodesis de rodilla, antes de considerar la amputación de la extremidad.

[Sensitivity and antibiotic resistance in infections of the musculoskeletal system]. / Sensibilidad y resistencia antibiótica en infecciones de sistema musculoesquelético.

BACKGROUND: Infections of the musculoskeletal system are a devastating complication for patients, due to it's long rehabilitation process and even sometimes the removal of the implant, the chronicity of infection, is often due to lack of coverage in empirical antibiotics. METHODS: A retrospective, observational, descriptive cohort study was performed. All cultures form musculoskeletal system infected patients reported of sensitivity and resistance of germs isolated were analyzed. RESULTS: A total of 143 positive results were included. Reported more frequent germ Staphylococcus aureus accounted for 75 positive cases, followed by Escherichia coli with 31 positive results. Antibiotics with better sensitivity according to the type of microorganisms were trimethoprim-sulfamethoxazole and vancomycin, levofloxacin and linezolid, gentamicin, erythromycin and amikacin. Regarding antibiotic resistance, those reported with the highest percentage were penicillin G, amoxicillin with clavulanic acid and ampicillin. CONCLUSIONS: We recommend using empirical treatments in musculoskeletal system infections, trimethoprim-sulfamethoxazole are the best choice because they have the same sensitivity compare with vancomycin and a resistance rate of 7.6%. Betalactamics have a high percentage of resistance and low sensitivity so we must consider alternatives.

Introducción: las infecciones de sistema musculoesquelético son una complicación grave para el paciente, debido a que prolongan el tiempo de recuperación y pueden llegar al retiro del implante o a la cronicidad de la infección con gasto excesivo para la institución y desgaste para el paciente y su familia. Métodos: estudio observacional en cirugías limpias programadas por patología crónicadegenerativa en el 2015. Se seleccionaron 225, que fueron reportadas como infectadas, a las que se les realizó cultivo. Se revisó la sensibilidad y resistencia de los microorganismos aislados con mayor frecuencia. Resultados: se incluyeron los cultivos y antibiogramas realizados a 225 pacientes, cumpliendo criterios de selección 143 resultados positivos. Se reportó Staphylococcus aureus, y Escherichia coli. Los antibióticos con mejor sensibilidad de acuerdo al tipo de microorganismos fueron trimetoprim-sulfametoxazol y vancomicina, levofloxacino y linezolid, gentamicina, eritromicina y amikacina. Respecto a la resistencia antibiótica, los de mayor porcentaje fueron la penicilina, amoxicilina con ácido clavulánico y ampicilina. Conclusiones: en las infecciones del sistema musculoesquelético estudiadas con cultivo y antibiograma, los dos microorganismos con mayor incidencia fueron S. aureus y E. coli, mostrando una mayor sensibilidad antibiótica para el trimetoprim-sulfametoxazol, muy similar a la vancomicina, así también el TMP-SMX mostró una resistencia baja. Los betalactámicos mostraron un alto porcentaje de resistencia y baja sensibilidad.

[Clinical and therapeutic approach to Klippel-Feil syndrome in the primary care medicine]. / Tratamiento en el primer nivel del síndrome de Klippel-Feil.

A case of Klippel-Feil syndrome in a female nine years is informed. The patient presented a clinical picture compatible with Klippel-Feil syndrome: short neck with joint movements diminished and low hair implantation. We showed the diagnostics and treatment approach at the primary medicine level, the follow-up until the presence of clinical manifestations of the main clinical problems associated. The liver, cardiovascular, audiology, and muscle-bones are describe and finally some aspects of her physical rehabilitation.