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1.
Bone Joint J ; 102-B(4): 470-477, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32228076

RESUMO

AIMS: Infected and deformed neuropathic feet and ankles are serious challenges for surgical management. In this study we present our experience in performing ankle arthrodesis in a closed manner, without surgical preparation of the joint surfaces by cartilaginous debridement, but instead using an Ilizarov ring fixator (IRF) for deformity correction and facilitating fusion, in arthritic neuropathic ankles with associated osteomyelitis. METHODS: We retrospectively reviewed all the patients who underwent closed ankle arthrodesis (CAA) in Ilizarov Scientific Centre from 2013 to 2018 (Group A) and compared them with a similar group of patients (Group B) who underwent open ankle arthrodesis (OAA). We then divided the neuropathic patients into three arthritic subgroups: Charcot joint, Charcot-Maire-Tooth disease, and post-traumatic arthritis. All arthrodeses were performed by using an Ilizarov ring fixator. All patients were followed up clinically and radiologically for a minimum of 12 months to assess union and function. RESULTS: The union rate for Group A was 81% (17/21) while it was 84.6% (33/39) for Group B. All the nonunions in Group A underwent revision with an open technique and achieved 100% union. Mean duration of IRF was 71.5 days (59 to 82) in Group A and 69 days (64.8 to 77.7) in Group B. The American Orthopaedic Foot and Ankle Society (AOFAS) hindfoot score was similar in both groups. The postoperative hospital stay was shorter in Group A (21 days (SD 8)) than Group B (28 days (SD 9)). In the latter Group there were more problems with wound healing and greater requirement for antibiotic treatment. The mean operating time was 40 minutes (SD 9) in Group A compared to 80 minutes (SD 13) in Group B. Recurrence of infection occurred in 19% (4/21) and 15.5% (6/39) for Group A and Group B respectively. CONCLUSION: We found CAA using an IRF to be an effective method for ankle arthrodesis in infected neuropathic foot and ankle cases and afforded comparable results to open methods. Due to its great advantages, Ilizarov method of CAA should always be considered for neuropathic ankles in suitable patients. Cite this article: Bone Joint J 2020;102-B(4):470-477.


Assuntos
Articulação do Tornozelo/cirurgia , Artrite Infecciosa/cirurgia , Artrodese/métodos , Artropatia Neurogênica/cirurgia , Técnica de Ilizarov , Deformidades Articulares Adquiridas/cirurgia , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Artrite Infecciosa/diagnóstico por imagem , Artrodese/instrumentação , Artropatia Neurogênica/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/diagnóstico por imagem , Doença de Charcot-Marie-Tooth/cirurgia , Feminino , Deformidades Adquiridas do Pé/diagnóstico por imagem , Deformidades Adquiridas do Pé/cirurgia , Humanos , Deformidades Articulares Adquiridas/diagnóstico por imagem , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Osteomielite/diagnóstico por imagem , Osteomielite/cirurgia , Radiografia , Recidiva , Reoperação/métodos , Estudos Retrospectivos , Fatores de Tempo , Cicatrização
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(1): 139-144, 2020 Jan 15.
Artigo em Chinês | MEDLINE | ID: mdl-31939249

RESUMO

Objective: To summarize the research progress of total hip arthroplasty (THA) in treatment of sequelae of suppurative hip arthritis. Methods: The relevant literature was systematically searched and the operation timing, treatments of acetabular and femoral sides, and prosthesis selection in THA for sequelae of suppurative hip arthritis were summarized. Results: THA is an effective way to treat the sequelae of suppurative hip arthritis. In order to avoid the recurrence of infection, THA is recommended to be performed after 10 years of resting period of hip septic infection. These patients may have acetabulum dysplasia and poor coverage of acetabulum. When performing THA, high position acetabulum, osteotomy of the medial acetabular wall, structural bone graft, Cage, tantalum augment, or three-dimensional printing prosthesis can be chosen. The femoral side may has small medullary cavity, increased femoral neck anteversion, increased femoral neck-stem angle, extend trochanter, and poor bone mass. When performing THA, the femoral osteotomy and appropriate prosthesis can be selected for treatment. The patients with sequelae of suppurative hip arthritis are mostly young, cementless THA is preferred for a better long-term survivorship. Conclusion: THA is an effective method for the sequelae of suppurative hip arthritis, but the operation is difficult and has relative high complication rate. Surgeons should have full understanding.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Luxação Congênita de Quadril , Prótese de Quadril , Acetábulo , Artrite Infecciosa/cirurgia , Humanos , Resultado do Tratamento
3.
Lancet Infect Dis ; 20(3): 341-349, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31862240

RESUMO

BACKGROUND: The short-term and long-term consequences of septic arthritis are uncertain. We aimed to determine risk of mortality and adverse joint outcomes following septic arthritis of the native knee. METHODS: We did a retrospective cohort study in patients who received arthroscopic knee washout for septic arthritis in England between April 1, 1997, and March 31, 2017, using data in the national Hospital Episode Statistics database. Patients with previous knee surgery to the same knee were excluded. Mortality within 90 days, adverse joint outcomes (arthrodesis, amputation, arthroplasty) within 1 year, and arthroplasty within 15 years were determined. Mortality in patients with a primary admitting diagnosis of septic arthritis (ICD-10) was compared with that in patients in whom septic arthritis was a secondary diagnosis. FINDINGS: 12 132 patients were included (mean age 56·6 years [SD 24·9]) of whom 4307 (36%) were female. In 10 195 (84%) patients with septic arthritis as the primary admitting diagnosis, 90-day mortality was 7·05% (95% CI 6·56-7·57; 719 patients), rising to 22·69% (20·80-24·68; 418 patients) in 1842 patients older than 79 years. Secondary septic arthritis diagnosis versus primary diagnosis was associated with an adjusted odds ratio for mortality of 2·10 (95% CI 1·79-2·46; p<0·0001). In 11 393 patients with at least 1 year follow-up, the 1 year rates were 0·13% (95% CI 0·07-0·22; 15 patients) for arthrodesis, 0·40% (0·30-0·54; 46 patients) for amputation, and 1·33%; (1·13-1·56; 152 patients) for arthroplasty. Within 15 years, 159 (8·76%; 95% CI 7·50-10·15) of 1816 patients had received arthroplasty, corresponding to an annual risk of arthroplasty that was about six times that of the general population (risk ratio 6·14, 95% CI 4·95-7·62; p<0·0001). INTERPRETATION: The consequences of septic knee arthritis in patients undergoing arthroscopic knee washout are serious. These findings highlight the potentially devastating outcomes associated with sepsis from musculoskeletal joint infection. FUNDING: National Institute for Health Research.


Assuntos
Artrite Infecciosa/mortalidade , Artrite Infecciosa/cirurgia , Artroscopia/métodos , Articulação do Joelho/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Inglaterra/epidemiologia , Feminino , Hospitais , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Medição de Risco , Análise de Sobrevida , Resultado do Tratamento , Adulto Jovem
4.
BMC Musculoskelet Disord ; 20(1): 583, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801510

RESUMO

BACKGROUND: There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. METHODS: A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n = 160) were collected every 24 h for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. RESULTS: There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p = 0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P = 0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. coli. CONCLUSIONS: The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty. (Chinese Clinical Trial Registry, ChiCTR-INR-17014162. Registered 26 December 2017.).


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa/cirurgia , Artroplastia de Quadril/métodos , Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Antibacterianos/química , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Cimentos para Ossos/química , Feminino , Articulação do Quadril/microbiologia , Articulação do Quadril/cirurgia , Prótese de Quadril/microbiologia , Humanos , Masculino , Meropeném/administração & dosagem , Meropeném/química , Metilmetacrilato/química , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Sucção/efeitos adversos , Sucção/métodos , Resultado do Tratamento , Vancomicina/administração & dosagem , Vancomicina/química
5.
BMC Musculoskelet Disord ; 20(1): 613, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864332

RESUMO

BACKGROUND: The two-stage revision protocol represents the current gold standard for treating infected total knee replacement implants. Allowing early mobility with weight-bearing between staged procedures will enable early restoration to knee function. So, the mechanical performance of knee spacers is a key issue. Commercially available moulds are often used as they are easy to prepare and produce smoother surfaces of the articulating parts. However, they are costly, and only for single use. A cost-effective alternative is the surgeon-made hand-moulded spacers. In this study, we wanted to determine how the hand-moulded spacers will compare biomechanically with the commercially available COPAL spacers. METHODS: Seven cadaveric knees were implanted with knee spacers fabricated using COPAL knee moulds. The same surgeon implanted eight cadaveric knees with hand-moulded spacers. In the first test protocol, an axial load was applied at 200 mm/min till failure. In the second test protocol, the knees were cyclically loaded in five steps of 1000 cycles each from 30-400 N, 30-600 N, 30-800 N, 30-1000 N, 30-1200 N at 1.5 Hz. RESULTS: COPAL knee spacers demonstrated a maximum load and mean stiffness of 5202 (± 486.9) N and 1098 (± 201.5) N/mm respectively. The hand-moulded knee spacers demonstrated a mean stiffness of 4509 (± 1092.6) N and 1008.7 (± 275.4) N/mm respectively. The maximum axial displacement was 1.19 ± 0.57 mm and 0.89 ± 0.30 mm for specimens implanted with COPAL knee spacers and hand-moulded spacers respectively. The differences between COPAL and hand-moulded knee spacers were not statistically different. CONCLUSIONS: Our study demonstrated that dynamic knee spacers may be able to withstand more than the touch-down load permitted in previous studies, and this may allow more weight-bearing during ambulation. Previous studies have demonstrated that hand-moulded knee spacers have similar advantages to commercially available dynamic spacers with respect to mobility, pain, bone loss, and reinfection rate. Given that ambulation with weight-bearing up to 1200 N is permitted during rehabilitation, it may be more cost-effective to fabricate hand-moulded spacers in revision total knee arthroplasty.


Assuntos
Artrite Infecciosa/cirurgia , Articulação do Joelho/cirurgia , Infecções Relacionadas à Prótese/cirurgia , Reoperação/instrumentação , Artrite Infecciosa/etiologia , Artroplastia do Joelho/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/etiologia
6.
Pan Afr Med J ; 33: 237, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31692731

RESUMO

The wrist is a rare location of septic arthritis. It often involves patients with preexisting joint disease which symptoms could be confused with infection making the diagnosis more difficult and usually delayed. It is often responsible for residual functional impairment and for a high mortality rate among vulnerable patients. We report 6 cases of septic arthritis of the wrist in 3 males and 3 females. The mean age was 32 years in the male patients and 66 in the female patients. All the women were followed for rheumatoid arthritis. Biological results showed elevated rates of white blood cells and c-reactive protein in all the patients. Joint fluid analyses showed elevated white blood cell count. The treatment was medico-surgical consisting in synovectomy, joint debridement and immobilization of the wrist. At the average follow-up of 1 year and 4 months, 3 patients recovered a perfect mobility of the wrist without any limitation of the range of motion nor the strength. Three patients developed stiffness of the wrist.


Assuntos
Artrite Infecciosa/cirurgia , Desbridamento/métodos , Articulação do Punho/cirurgia , Adulto , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/patologia , Artrite Reumatoide/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Articulação do Punho/patologia
7.
Acta Chir Orthop Traumatol Cech ; 86(5): 358-361, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31748112

RESUMO

PURPOSE OF THE STUDY Arthrodesis of interphalangeal joints of the hand is a method used to treat conditions associated with joint destruction, instability and pain. Our study aims to evaluate the outcomes of the treatment of sequelae of septic arthritis of interphalangeal joints by arthrodesis with external fixation. This topic is hardly covered in literature. Moreover, it compares the outcomes of application of this method in diabetic patients and non-diabetic population. MATERIAL AND METHODS Arthrodesis by means of Stellbrink external fixator was performed in 17 patients who had suffered septic arthritis of interphalangeal joints of the hand. The following parameters were followed in patients in our group: age, sex, etiology of disease, smoking, diabetes, affected fingers and joints of the hand, side, microbial culture finding, wound healing, postoperative ATB therapy and its duration, radiographic signs of the union of arthrodesis and potential complications. RESULTS The group included 8 men and 9 women. The mean age was 66.2 years. 5 patients in the group were diabetic. In 16 patients the wound healed per primam, in 1 case per secundam. The average duration of postoperative ATB therapy was 4.3 weeks. The X-ray showed the union of fused articular surfaces at 6.9 weeks on average. Complications occurred in 3 patients, namely 1 case of secondary wound healing, 1 case of nail bed damage and 1 case of flexor tenosynovitis of the operated finger. The arthrodesis was successfully healed in all the patients and a no difference was detected between diabetic and nondiabetic patients. DISCUSSION When arthrodesis of interphalangeal joints of the hand is performed using an external fixator, the metal material is introduced outside the area of inflammation, or the field potentially at risk of infection, therefore this method is predetermined for surgeries in the terrain changed by inflammation or potentially at risk of inflammation. Compared to the other methods such as arthrodesis by inserting K-wires intramedullary, there is no risk of migration of the metal material and the associated soft tissue irritation. CONCLUSIONS Our study confirms the safety and efficiency of arthrodesis of interphalangeal joints of the hand by means of an external fixator in treating the sequelae of septic arthritis. The union of arthrodesis with no complications was observed even in all the diabetic patients. Ranking among the main advantages of this method are the easy care for the surgical wound, achievement of easy and firm fixation with the possibility to apply an external fixator outside the area of the original infection. Key words:arthrodesis, external fixator, septic arthritis, interphalangeal joint.


Assuntos
Artrite Infecciosa/cirurgia , Artrodese/instrumentação , Articulações dos Dedos/cirurgia , Idoso , Artrite Infecciosa/complicações , Artrodese/métodos , Fios Ortopédicos , Complicações do Diabetes/complicações , Fixadores Externos , Feminino , Humanos , Masculino , Resultado do Tratamento
8.
Tokai J Exp Clin Med ; 44(4): 113-117, 2019 Dec 20.
Artigo em Inglês | MEDLINE | ID: mdl-31769001

RESUMO

A 5-year-old girl was referred to our institution with complaints of right hip pain and fever (39.0°C); blood tests and magnetic resonance imaging (MRI) were performed. Blood biochemical results revealed a high inflammatory reaction. MRI results revealed inflammation in the hip joint. She was diagnosed with pediatric septic arthritis of the hip, which required arthrotomy and lavage drainage. Treatment with intravenous vancomycin was initiated on the assumption that the causative bacterial species was Staphylococcus aureus. However, Group A Streptococcus pyogenes (GAS) was subsequently isolated from an intraoperative sample, and the antimicrobial agent was switched to aminobenzylpenicillin (ABPC). Clindamycin (CLDM) was added to the treatment regimen 14 days after surgery as MRI indicated the development and spread of osteomyelitis. Three months post-surgery, MRI findings indicated that the osteomyelitis had resolved and antimicrobial therapy was discontinued. To prevent the spread of osteomyelitis, a combination of CLDM and ABPC should be considered at an early stage, particularly in pediatric patients with GAS-induced septic arthritis.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Clindamicina/uso terapêutico , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Quadril/microbiologia , Osteomielite/tratamento farmacológico , Antibacterianos/administração & dosagem , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/cirurgia , Pré-Escolar , Clindamicina/administração & dosagem , Feminino , Infecções por Bactérias Gram-Positivas/diagnóstico , Infecções por Bactérias Gram-Positivas/cirurgia , Cocos Gram-Positivos/efeitos dos fármacos , Cocos Gram-Positivos/isolamento & purificação , Quadril/diagnóstico por imagem , Quadril/cirurgia , Humanos , Imagem por Ressonância Magnética , Osteomielite/diagnóstico , Osteomielite/cirurgia
9.
Agri ; 31(4): 202-205, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31741348

RESUMO

Congenital insensitivity to pain with anhidrosis (CIPA) is a rare syndrome characterized by a lack of sensitivity to pain due to congenital sensory and autonomic neuropathies, anhidrosis, an inability to regulate body temperature, growth retardation, mental retardation at different levels of severity, and inadvertent self-harm. It is an autosomal recessive disorder that is result of a mutation in the neurotrophic receptor tyrosine kinase 1 gene, which encodes neurotrophic tyrosine kinase. CIPA patients are frequently admitted to hospitals with unrecognized traumatic fractures and unhealed wounds due to the lack of a pain response. Presently described is the method of anesthetic management used for 2 siblings, aged 17 and 14 years, with a generalized lack of pain, anhidrosis, mental retardation, and septic arthritis. Sedation with midazolam alone provided satisfactory surgical comfort without causing hemodynamic instability in these 2 patients with CIPA syndrome.


Assuntos
Anestesia , Articulação do Tornozelo/cirurgia , Artrite Infecciosa/cirurgia , Neuropatias Hereditárias Sensoriais e Autônomas , Hipnóticos e Sedativos/uso terapêutico , Midazolam/uso terapêutico , Adolescente , Feminino , Humanos , Masculino , Medição da Dor , Irmãos
10.
J Shoulder Elbow Surg ; 28(12): 2317-2325, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31377005

RESUMO

BACKGROUND: There is no standard to determine the most appropriate method of operation for the treatment of acute septic arthritis of the shoulder joint. METHODS: We retrospectively reviewed 57 patients who underwent arthroscopic or open débridement for acute shoulder infection between 2001 and 2015. Arthroscopic débridement was performed in 27 patients, and open débridement in 30 patients. According to the presence of bone erosion and/or marginal erosion of cartilage of the humeral head on plain radiographs and magnetic resonance imaging (MRI) images, the cases were classified into 3 groups (group 1, n = 23, without erosions in x-ray and MRI; group 2, n = 21, erosions seen in MRI but not in x-ray; and group 3, n = 13, with erosions seen in both x-ray and MRI). RESULTS: The arthroscopic group had a reinfection rate of 55.6% (15/27), and the open group had a reinfection rate of 16.7% (5/30). The reinfection rates in the arthroscopic and the open groups were 10% (1/10) and 15.4% (2/13) in group 1; 75% (9/12) and 11.1% (1/9) in group 2; and 100% (5/5) and 25% (2/8) in group 3, respectively. At the last follow-up, the mean University of California at Los Angeles score and the average time until normalization of white blood cell, erythrocyte sedimentation rate, and C-reactive protein in the open group showed superior results in the open group (all P < .05). CONCLUSIONS: When preoperative MRI showed bone and/or cartilage erosion of humeral head, the reinfection rate after arthroscopic débridement was above 75%. Therefore, if preoperative MRI showed erosions, open débridement is more likely to be appropriate than arthroscopic débridement.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Desbridamento/métodos , Cabeça do Úmero/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/sangue , Artroscopia , Sedimentação Sanguínea , Proteína C-Reativa/metabolismo , Feminino , Humanos , Contagem de Leucócitos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório , Radiografia , Recidiva , Estudos Retrospectivos , Ombro , Resultado do Tratamento , Adulto Jovem
11.
Medicine (Baltimore) ; 98(32): e16765, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393395

RESUMO

Primary septic arthritis of the hip is rare and potentially devastating in adults. Its optimal surgical treatment and clinical outcomes remain unclear.In this retrospective cohort study, we investigated mortality and reinfection rates after surgery of patients with septic hip arthritis. We reviewed patients treated for primary septic hip joints from October 2005 to December 2016. A total of 51 adult patients were identified, and 38 among them had destructive hip joints. A poor postoperative outcome was defined as mortality or recurrent infection within 2 years of surgery.After surgery, 7 (13.7%) patients died within 1 year and 5 (9.8%) patients developed a recurrent hip infection within 2 years. Therefore, poor outcomes occurred in 22% (n = 11) of the study cohort. Among the 38 patients with a destructive hip joint, 7 (18.4%) died within 1 year after surgery and 4 (10.5%) developed a recurrent hip infection within 2 years of surgery. Correlative infections other than infected hip joint and liver cirrhosis were identified as risk factors for poor outcomes.In conclusion, clinical physicians treating adult primary septic hip joints should be cognizant of the high failure rate of surgical treatment. In addition, the high mortality rate should be considered during the discussion of surgical treatment with these patients and their families.


Assuntos
Artrite Infecciosa/mortalidade , Artrite Infecciosa/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/complicações , Coinfecção/epidemiologia , Comorbidade , Desbridamento/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Análise de Sobrevida
12.
Infect Dis (Lond) ; 51(9): 694-700, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31355687

RESUMO

Background: Aggressive surgery such as en bloc joint resection is favored for treating uncommon sternoclavicular (SC) septic arthritis, based on expert opinion and small case series. We analyzed the clinical characteristics and treatment outcomes of patients with Staphylococcus aureus SC septic arthritis treated medically or with limited surgery. Methods: All adult patients with this septic arthritis at the Asan Medical Center between September 2009 and December 2016 were reviewed. Limited surgery was defined as simple incision, drainage, and debridement of the infected joint. Results: Of 22 patients enrolled, 11 received medical treatment only, and 11 underwent limited surgery, and none underwent aggressive surgery. Most patients (73%) had underlying predisposing conditions such as infection at a distant site, diabetes and liver cirrhosis, and none had intravenous drug abuse or HIV infection. Complications such as chest wall and/or neck abscess, clavicular and/or sternal osteomyelitis were identified in 18 patients (82%). Patients with chest wall and/or neck abscesses tended more often to undergo limited surgery than patients without such abscesses (73% vs. 27%, p = .09). The median duration of intravenous antibiotics was 35 days (IQR, 25-46 days). Treatment was successful in all cases. In a median 53-week follow-up (IQR, 8-171 weeks), there was no relapse of arthritis or joint deterioration. Conclusions: Medical treatment alone or with limited surgery could be successful therapeutic strategies for complicated S. aureus SC septic arthritis in selected patients.


Assuntos
Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Articulação Esternoclavicular/microbiologia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/tratamento farmacológico , Staphylococcus aureus/efeitos dos fármacos , Resultado do Tratamento
13.
Bone Joint J ; 101-B(7_Supple_C): 91-97, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31256641

RESUMO

AIMS: There is little information regarding the risk of a patient developing prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA) when the patient has previously experienced PJI of a TKA or total hip arthroplasty (THA) in another joint. The goal of this study was to compare the risk of PJI of primary TKA in this patient population against matched controls. PATIENTS AND METHODS: We retrospectively reviewed 95 patients (102 primary TKAs) treated between 2000 and 2014 with a history of PJI in another TKA or THA. A total of 50 patients (53%) were female. Mean age was 69 years (45 to 88) with a mean body mass index (BMI) of 36 kg/m2 (22 to 59). In total, 27% of patients were on chronic antibiotic suppression. Mean follow-up was six years (2 to 16). We 1:3 matched these (for age, sex, BMI, and surgical year) to 306 primary TKAs performed in 306 patients with a THA or TKA of another joint without a subsequent PJI. Competing risk with death was used for statistical analysis. Multivariate analysis was followed to evaluate risk factors for PJI in the study cohort. RESULTS: The cumulative incidence of PJI in the study cohort (6.1%) was significantly higher than the matched cohort (2.6%) at ten years (hazard ratio (HR) 3.3; 95% confidence interval 1.18 to 8.97; p = 0.02). Host grade in the study group was not a significant risk factor for PJI. Patients on chronic suppression had a higher rate of PJI (HR 15; p = 0.002), with six of the seven patients developing PJI in the study group being on chronic suppression. The new infecting microorganism was the same as the previous in only two of seven patients. CONCLUSION: In this matched cohort study, patients undergoing a clean primary TKA with a history of TKA or THA PJI in another joint had a three-fold higher risk of PJI compared with matched controls with ten-year cumulative incidence of 6.1%. The risk of PJI was 15-fold higher in patients on chronic antibiotic suppression; further investigation into reasons for this and mitigation strategies are recommended. Cite this article: Bone Joint J 2019;101-B(7 Supple C):91-97.


Assuntos
Artrite Infecciosa/complicações , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Previsões , Infecções Relacionadas à Prótese/etiologia , Idoso , Idoso de 80 Anos ou mais , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/cirurgia , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/epidemiologia , Reoperação , Estudos Retrospectivos , Fatores de Risco , Estados Unidos/epidemiologia
14.
Arthroscopy ; 35(7): 1984-1991, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31196694

RESUMO

PURPOSE: To compare the efficacy, as measured through the rate of reoperation, and rates of other 30-day perioperative complications between arthrotomy and arthroscopy for the treatment of septic native shoulders in a national patient population. METHODS: Patients who were diagnosed with septic arthritis in a native shoulder and underwent irrigation and debridement through arthrotomy or arthroscopy were identified in the 2005-2016 National Surgical Quality Improvement Program database. Patient preoperative characteristics were characterized. Rate of reoperation, a proxy used to measure treatment efficacy, and other perioperative complications were compared between the 2 procedures. RESULTS: In total, 100 patients undergoing shoulder arthrotomy and 155 patients undergoing shoulder arthroscopy for septic shoulder were identified. On univariate analysis, there were no statistically significant differences in patient preoperative characteristics, operative time (60 vs. 48 minutes, P = .290), length of stay (7.5 vs. 6.6 days, P = .267), or time to reoperation (8.9 vs. 7.2 days, P = .594) between the 2 surgical groups. On multivariate analysis controlling for patient characteristics, there were no statistically significant differences in risk of reoperation (relative risk [RR] = 1.914, 99% confidence interval [CI] = 0.730-5.016, P = .083), any adverse events (RR = 1.254, 99% CI = 0.860-1.831, P = .122), minor adverse events (RR = 1.304, 99% CI = 0.558-3.047, P = .421), serious adverse events (RR = 1.306, 99% CI = 0.842-2.025, P = .118), or readmission (RR = 0.999, 99% CI = 0.441-2.261, P = .998) comparing arthrotomy with arthroscopy. CONCLUSIONS: By demonstrating similar rates of reoperation, other postoperative complications, and 30-day readmissions, the current study suggests that arthrotomy and arthroscopic surgery have similar efficacy in treating septic shoulders. However, owing to the small sample size, there is still the possibility of a type II error. LEVEL OF EVIDENCE: Level III, therapeutic retrospective comparative study.


Assuntos
Artrite Infecciosa/cirurgia , Artroscopia/métodos , Desbridamento/métodos , Articulação do Ombro/cirurgia , Técnicas de Sutura/instrumentação , Suturas , Adulto , Idoso , Artrite Infecciosa/diagnóstico , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/fisiopatologia , Resultado do Tratamento
16.
BMJ Case Rep ; 12(5)2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133553

RESUMO

Septic arthritis usually presents as subacute monoarticular inflammation. Majority of the cases in healthy adults are caused by methicillin-resistant Staphylococcus aureus, streptococci and certain gram-negative organisms, mostly in the setting of extremes of ages, trauma or immunosuppression. This is a case of a healthy adult with a sudden onset of inflammation of the knee joint, being diagnosed with septic arthritis of the left knee with Veillonella sp. growing from the joint aspirate on two successive cultures. The patient was treated with 6 weeks of oral metronidazole and 4 weeks of intravenous ceftriaxone in addition to arthroscopic drainage and irrigation. Rare causes of septic arthritis should be considered even in healthy adults with native joints. Closer follow-up might be needed to ensure successful treatment.


Assuntos
Artrite Infecciosa/microbiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Articulação do Joelho/microbiologia , Veillonella/isolamento & purificação , Antibacterianos/uso terapêutico , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/cirurgia , Artroscopia/métodos , Diagnóstico Diferencial , Drenagem/métodos , Feminino , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Doenças Raras , Resultado do Tratamento
17.
Orthop Traumatol Surg Res ; 105(4): 647-651, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31047841

RESUMO

BACKGROUND: Prosthetic joint infection (PJI) is a rare (incidence, 0.15% to 0.9%) but serious complication of knee arthroplasty. Haematogenous PJI of the knee (KhPJI) which accounts for 10% of cases, has been less studied than PJI due to other mechanisms. The primary objective of this study in patients with KhPJI of the knee was to determine the 2-year infection eradication failure rate after either exchange arthroplasty or arthrotomy/synovectomy/irrigation (ASI), combined with prolonged peri-operative antibiotic therapy, at a referral centre for complex osteo-articular infections. HYPOTHESIS: ASI within 2 weeks after symptom onset and one-stage exchange arthroplasty produce similar 2-year success rates in patients with KhPJI of the knee. MATERIAL AND METHODS: A prospective observational cohort study was performed in patients managed for PJI of the knee between 2003 and 2015. The primary outcome measure was the occurrence of a septic event or of KhPJI -related death during a minimum follow-up of 2 years. RESULTS: Of 265 patients with PJI after total knee arthroplasty, 58 (22.1%) had KhPJI with onset more than 3 months after the last arthroplasty procedure and were included in the study. Among them, one-third had immune deficiencies. The most common causative organisms were streptococci (n=25, 43%) and Staphylococcusaureus (n=20, 34%). The primary focus of infection was identified in only 64% of patients and was most often cutaneous (n=19, 33%) or dental (n=11, 19%). A septic event or KhPJI-related death occurred in 5/34 (15%) patients after one-stage exchange arthroplasty and 6/19 (32%) patients after ASI within 15 days after symptom onset (p=0.03). Patient characteristics, type of prosthesis, and causative organism were not significantly associated with failure to eradicate the infection. CONCLUSION: ASI carried a high failure rate despite being performed within 15 days after symptom onset. One-stage exchange arthroplasty seems to be the best surgical option, particularly as the exact time of symptom onset may be difficult to determine. Identifying and eradicating the primary focus of infection is crucial. LEVEL OF EVIDENCE: II, low-powered prospective cohort study.


Assuntos
Artrite Infecciosa/diagnóstico , Artroplastia do Joelho/efeitos adversos , Bacteriemia/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/cirurgia , Bacteriemia/tratamento farmacológico , Bacteriemia/cirurgia , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Sinovectomia , Irrigação Terapêutica , Falha de Tratamento
18.
Ann Rheum Dis ; 78(8): 1114-1121, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30992295

RESUMO

OBJECTIVE: The optimal duration of postsurgical antibiotic therapy for adult native joint bacterial arthritis remains unknown. METHODS: We conducted a prospective, unblinded, randomised, non-inferiority study comparing either 2 or 4 weeks of antibiotic therapy after surgical drainage of native joint bacterial arthritis in adults. Excluded were implant-related infections, episodes without surgical lavage and episodes with a follow-up of less than 2 months. RESULTS: We enrolled 154 cases: 77 in the 4-week arm and 77 in the 2-week arm. Median length of intravenous antibiotic treatment was 1 and 2 days, respectively. The median number of surgical lavages was 1 in both arms. Recurrence of infection was noted in three patients (2%): 1 in the 2-week arm (99% cure rate) and 2 in the 4-week arm (97% cure rate). There was no difference in the number of adverse events or sequelae between the study arms. Of the overall 154 arthritis cases, 99 concerned the hand and wrist, for which an additional subgroup analysis was performed. In this per-protocol subanalysis, we noted three recurrences: one in the 2-week arm (97 % cure); two in the 4-week arm (96 % cure) and witnessed sequelae in 50% in the 2-week arm versus 55% in the 4-week arm, of which five (13%) and six (13%) needed further interventions. CONCLUSIONS: After initial surgical lavage for septic arthritis, 2 weeks of targeted antibiotic therapy is not inferior to 4 weeks regarding cure rate, adverse events or sequelae and leads to a significantly shorter hospital stay, at least for hand and wrist arthritis. TRIAL REGISTRATION NUMBER: NCT03615781.


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/cirurgia , Drenagem/métodos , Adulto , Antibacterianos/farmacologia , Artrite Infecciosa/microbiologia , Bases de Dados Factuais , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Articulação da Mão/efeitos dos fármacos , Articulação da Mão/fisiopatologia , Hospitalização/estatística & dados numéricos , Hospitais Universitários , Humanos , Infusões Intravenosas , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Tempo , Resultado do Tratamento , Articulação do Punho/efeitos dos fármacos , Articulação do Punho/fisiopatologia
19.
J Arthroplasty ; 34(6): 1207-1213, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30872035

RESUMO

BACKGROUND: Historically, infection control rates with debridement and component retention have been poor in the management of acute prosthetic joint infections. We previously described a 2-stage debridement with prosthesis retention protocol for acute periprosthetic joint infection and reported a 90% success rate in a sample of 20 patients. METHODS: A retrospective review of 83 patients who underwent a 2-stage debridement with implant retention with a minimum 1-year follow-up was performed. Patient data were primarily analyzed to determine infection control rates. Infections were considered controlled when patients had not undergone a reoperation for infection, and demonstrated lack of any clinical signs or symptoms of infection (a well healed wound, diminishing swelling and warmth, absence of erythema, improvement in baseline pain symptoms) A secondary goal of this study was to examine the effects of symptom duration on infection control rate. RESULTS: Average patient follow-up was 41.8 months (range 12-171) for all patients. The overall protocol success rate was 86.7% (72/83): 82.9% in hips and 89.6% in knees. Additionally, protocol success was observed in 45 of 48 primary joints (93.8%) and 27 of 35 (77.1%) revision joints (P = .046). Average time from onset of symptoms to surgery was 6.2 days for successfully treated patients (range 0-27 days) compared to 10.7 days for those who failed treatment (range 1-28 days, P = .070). CONCLUSION: This 2-stage retention protocol resulted in a higher likelihood of infection control compared to prior reports of single stage debridement and modular part exchange.


Assuntos
Artrite Infecciosa/cirurgia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Desbridamento/métodos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Artrite Infecciosa/tratamento farmacológico , Artrite Infecciosa/etiologia , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/estatística & dados numéricos , Desbridamento/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Retenção da Prótese , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/etiologia , Reoperação/métodos , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Resultado do Tratamento
20.
J Arthroplasty ; 34(6): 1201-1206, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30879874

RESUMO

BACKGROUND: Antibiotic cement spacers are used during 2-stage revision total hip arthroplasty for prosthetic joint infection. Complications including dislocation and periprosthetic fracture have been reported but a large cohort comparing spacer design features is lacking. We aimed to determine if spacer design is associated with perioperative complications. METHODS: We performed a retrospective review of antibiotic cement spacers implanted between 2004 and 2014. Radiographic assessment included leg length, offset, and bone loss (Paprosky classification). Clinical outcomes included dislocation, periprosthetic fracture, spacer fracture, infection cure, and overall reoperation rate. Univariate analysis, Student's t-test, chi-squared test, or Kruskal-Wallis test was employed (P < .05). RESULTS: One hundred eighty-five patients were treated: 42% were female and mean age was 64 years (range 24-93, standard deviation 13.6). Spacer types were (1) molded (53%), (2) antibiotic-coated prosthesis (30%), (3) handmade (12%); and (4) prefabricated (4%). Cemented acetabular liners were used in 3% (6/185). There was no loss to follow-up during the interstage period. Spacer complications occurred in 26% (48/185). Dislocation occurred in 9% (17/185) and was associated with reduced femoral offset of >5 mm (P = .033) and increased bone loss (P = .01). Spacer fracture occurred in 8% (14/185); 12% (12/97) molded versus 8% (2/23) handmade (P = .02). Periprosthetic femur fracture was associated with increased offset >5 mm (P = .01) and extended trochanteric osteotomy (P = .001). CONCLUSION: During 2-stage total hip arthroplasty, antibiotic-loaded cement spacers had an overall complication rate of 26%. Spacer design, acetabular and femoral bone loss, and offset restoration were significantly associated with perioperative complications. We recommend the optimization of antibiotic-loaded cement spacer placement to minimize potential complications by focusing on restoration of leg-length and offset, ensuring adequate femoral fixation and paying attention to selection of an appropriate head/neck ratio.


Assuntos
Artrite Infecciosa/cirurgia , Artroplastia de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/efeitos adversos , Reoperação/instrumentação , Acetábulo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Artrite Infecciosa/etiologia , Cimentos para Ossos , Feminino , Fêmur/cirurgia , Prótese de Quadril/efeitos adversos , Humanos , Luxações Articulares/etiologia , Articulações/cirurgia , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/etiologia , Infecções Relacionadas à Prótese/etiologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Adulto Jovem
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