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1.
Acta Chir Orthop Traumatol Cech ; 89(4): 286-292, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36055669

RESUMO

PURPOSE OF THE STUDY To compare topical and intravenous (IV) administration of tranexamic acid (TXA) 2 g in patients undergoing total hip arthroplasty (THA), or total knee arthroplasty (TKA). MATERIAL AND METHODS In total, 452 patients undergoing THA or TKA were randomised to 3 groups: 1) the IV TXA group received 2 doses of TXA 1 g intravenously 3 hours apart; 2) the topical TXA group received TXA 2 g topically, and 3) the NO TXA - control group. Furthermore, each group was divided in two subgroups by performed surgery (THA versus TKA). The following endpoints were used for final analysis: postoperative blood loss, transfusion requirement, haemoglobin drop and postoperative complications (haematoma, surgical site infection, thromboembolism, early surgical revision). RESULTS Both topical and IV administration of TXA significantly reduced postoperative bleeding (mean ± standard deviation) after THA and TKA (topical 504.4±281.0 ml, IV 497.3±251.7 ml, NO 863.1±326.4 ml, p<0.001). Topical use was superior to IV in reducing postoperative drainage output in THA (topical 377±213.3 ml, IV 518.1±259.0 ml, p<0.01). On the opposite, IV use was superior to topical in drainage output in TKA (topical 646.1±281.3 ml, IV 457.8±235.8 ml, p<0.01). The differences in transfusion requirement and Hb drop between these administration methods were not statistically significant (p≥0.05), but any TXA administration was significantly better than no TXA in all endpoints of efficacy (p<0.001). The lowest complication rate was observed in the topical group (NO 24%, IV 19%, topical 7.5%). DISCUSSION Consensus on optimal TXA dosing regime in primary hip and knee arthroplasties is still missing. Use of TXA therapy in routine clinical practice is highly individualized in accordance with the current approach of personalized medicine. Topical application seems to be the safest route of TXA administration. However, precise application technique is essential. IV TXA is beneficial especially in patients with some bleeding coagulopathies undergoing TKA with a tourniquet. Repeat doses of TXA are not usually necessary after completed primary arthroplasties. CONCLUSIONS IV and topical TXA 2 g have similar effect on reduction of transfusion requirements and haemoglobin drop in THA and TKA. The IV route is superior to topical in TKA while topical TXA reduces complications in both THA and TKA. Key words: tranexamic acid, total hip arthroplasty, total knee arthroplasty, topical administration, intravenous administration.


Assuntos
Antifibrinolíticos , Artroplastia de Quadril , Artroplastia do Joelho , Ácido Tranexâmico , Administração Intravenosa , Administração Tópica , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Hemoglobinas , Humanos
2.
J Orthop Surg Res ; 17(1): 407, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064425

RESUMO

BACKGROUND: Mobile-bearing unicompartmental knee arthroplasty (MB-UKA) is an effective treatment for anteromedial knee osteoarthritis. Meticulous intraoperative soft tissue balancing remains challenging yet consequential for a successful operation. Currently, surgeons rely mostly on their experience during soft tissue balancing, yielding unreproducible results. The purpose of this study was to quantified measure the soft tissue tension of medial compartment and determine if an optimal "target" tension values with the natural state exists. METHODS: This was an observational study of 24 consecutive patients. All 30 UKAs were performed by a single surgeon. The piezoresistive sensor was custom designed to fit in the medial compartment gap. Contact pressures were measured at 5 angular positions of the knee intraoperatively: 0°, 20°, 45°, 90°, and 110° of flexion. The change in pressure from extension (20° position) and flexion (110° position) was also calculated (E-FPD). Data on age, sex, body mass index, operative side, and bearing size were collected. Outcome measures were measured at baseline and at the 6-month postoperative follow-up; Oxford Knee Score, visual analog scale score, and range of motion were compared to evaluate clinical outcomes. RESULTS: There was a significant improvement in patients in all measured outcomes at 6 months from baseline (P < 0.05). The E-FPD of 14.9 N (8.9, 24.6) was indicative of appropriate soft tissue balancing throughout the functional range of knee motion. Of 30 knees, 22 were 3-mm bearing and 8 were 4- or 5-mm bearing. The pressure data of the 3-mm bearing group was larger than that of the non-3-mm bearing group for each knee flexion degree, but the difference was not statistically significant (P > 0.05). CONCLUSIONS: Objective data from sensor output may assist surgeons in decreasing loading variability during MB-UKA. The data suggested that MB-UKA could not accurately restore soft tissue tension to the natural state, which was related to the inability of MB-UKA surgical instruments to fine adjust the bone cut and soft tissue release. STUDY REGISTRATION: Chinese Clinical Trial Registry ( http://www.chictr.org.cn ): ChiCTR1900024146.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/métodos , Humanos , Articulação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Amplitude de Movimento Articular
3.
J Orthop Surg Res ; 17(1): 403, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064582

RESUMO

BACKGROUND: The purpose of this study was to evaluate the reproducibility of planned component positioning including tibial rotational alignment in patient-specific instrumentation (PSI) for total knee arthroplasty (TKA). METHODS: A total of 100 knees of 100 patients underwent TKA using PSI (n = 50) or the conventional method (n = 50). Full-length anteroposterior radiographs of the lower limb were taken in the standing position, and the coronal alignments of the femoral and tibial components were measured. Computed tomography (CT) images of the lower limb were obtained preoperatively and postoperatively, and the rotational alignments of the femoral and tibial components were measured. The difference from the preoperative planning in tibial rotational alignment was measured using three-dimensionally merged pre- and postoperative images. The mean values and rates of outliers in each measurement were compared between the PSI group and the conventional group. RESULTS: There were no significant differences in coronal alignment of the femoral and tibial components and rotational alignment of the femoral component between the two groups. With respect to rotational alignment of the tibial component from the preoperatively planned reference axis, the PSI group showed a lower rate of outliers (internal rotation > 10°) than the conventional group (p < 0.05). CONCLUSIONS: This study demonstrated that the difference from the preoperative planning in tibial rotational positioning was accurately evaluated using novel three-dimensional measurement method, and PSI could reduce outliers in rotational alignment of the tibial component (internal rotation > 10°). PSI is a useful technique for improving the reproducibility of the planned tibial rotational positioning in TKA.


Assuntos
Artroplastia do Joelho , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Extremidade Inferior , Reprodutibilidade dos Testes , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
4.
Sci Rep ; 12(1): 15094, 2022 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-36064964

RESUMO

A growing number of recent investigations on the human genome, gut microbiome, and proteomics suggests that the loss of mucosal barrier function, particularly in the gastrointestinal tract, may substantially affect antigen trafficking, ultimately influencing the close bidirectional interaction between the gut microbiome and the immune system. This cross-talk is highly influential in shaping the host immune system function and ultimately affecting the outcome of interventions. We hypothesized that the loss of mucosal barrier in the gut may be associatedto acute and chronic periprosthetic joint infections (PJI). Zonulin, soluble CD14 (sCD14), and lipopolysaccharide (LPS) were tested in plasma as part of a prospective cohort study of patients undergoing primary arthroplasty or revision arthroplasty because of an aseptic failure or PJI (as defined by the 2018 criteria). All blood samples were collected before antibiotic administration. Samples were tested using commercially available enzyme-linked immunosorbent assays as markers for gut permeability. A total of 134 patients were included in the study of which 44 patients had PJI (30 chronic and 14 acute), and the remaining 90 patients were categorized as non-infected that included 64 patients revised for aseptic failure, and 26 patients undergoing primary total joint arthroplasty. Both Zonulin (7.642 ± 6.077 ng/mL vs 4.560 ± 3.833 ng/mL; p < 0.001) and sCD14 levels (555.721 ± 216.659 ng/mL vs 396.872 ± 247.920 ng/mL; p = 0.003) were significantly elevated in the PJI group compared to non-infected cases. Higher levels of Zonulin were found in acute infections compared to chronic PJI (11.595 ± 6.722 ng/mL vs. 5.798 ± 4.841 ng/mL; p = 0.005). This prospective study reveals a possible link between gut permeability and the 'gut-immune-joint axis' in PJI. If this association continues to be borne out with a larger cohort and more in-depth analysis, it will have a clinically significant implication in managing patients with PJI. It may be that in addition to the administration of antimicrobials, patients with PJI and other orthopaedic infections may benefit from administration of gastrointestinal modulators such as pro and prebiotics.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Infecções Relacionadas à Prótese , Artrite Infecciosa/etiologia , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Humanos , Receptores de Lipopolissacarídeos , Permeabilidade , Estudos Prospectivos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/efeitos adversos , Estudos Retrospectivos
5.
BMC Musculoskelet Disord ; 23(1): 845, 2022 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-36068507

RESUMO

BACKGROUND: Globally the volume of total knee arthroplasty (TKA) is on the rise, reflecting aging populations, an associated increase in treatment of osteoarthritis, and a desire for improved quality of life. There is evidence that as high as 15 to 20% of patients are not satisfied with their TKA results and efforts need to be made to improve these rates. This study set out to identify what patients consider important when reflecting on TKA satisfaction, to pave the way to identifying service transformation opportunities that will enhance patient-centred care and satisfaction with this procedure. METHODS: Twenty-seven TKA recipients were recruited in the province of British Columbia, Canada. Semi-structured interviews were conducted about participants' experience and satisfaction with TKA, three to four years post-surgery. Grounded theory was employed to analyze participants' stories about what was front of mind when they reflected on satisfaction with their new knee. RESULTS: Participants described their post-TKA knee in terms its adequacy: how it felt and worked, and how it matched their pre-surgical expectations. The central element of their stories was the process of adapting, which gave rise to their perceptions of adequacy. Adapting comprises the patient experience of physically integrating and cognitively accepting their new knee. Patterns of adapting reflect the level of the new knee's achieved adequacy and the straightforwardness of the adapting process. DISCUSSION: The conceptualization of adequacy and the process of adapting allow a patient-centred understanding of what patients experience following TKA. For participants who did not readily achieve the adequacy they had anticipated, the challenges they experienced during adapting dominated their stories. Participants' adapting stories afford key insights into how the health care system could adjust to better support TKA patients, and improve rates of satisfaction with this procedure. CONCLUSIONS: The process of adapting lends itself to system intervention in support of enhanced post-TKA outcomes and satisfaction. These interventions could include the development of a care model including long-term clinical support for patients whose knees do not achieve desired results on schedule, and collaborating with patients to set and manage reasonable expectations about how their post-TKA knee will feel and function.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/métodos , Colúmbia Britânica , Teoria Fundamentada , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Satisfação do Paciente , Qualidade de Vida
7.
Biomed Res Int ; 2022: 4546836, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36072468

RESUMO

Submaximal levels of effort are required for the performance of the most common daily tasks. Inaccuracy in modulating motor outputs during submaximal tasks has been reported as indicator of safety during daily activities in subjects with lower limb musculoskeletal disorders. The study is aimed at investigating performance modulation ability during motor and functional tasks in patients after total knee arthroplasty (TKA). Sixteen patients with end-stage osteoarthritis undergoing TKA and twenty age-matched healthy participants performed isokinetic knee extension, sit-to-stand, and walking tasks at three levels of self-estimated effort (100%, 50%, and 25%) the day before (T0) and 4 days after surgery (T1). Maximum performance in terms of peak torque (PT-knee extension), overshoot (OS-sit-to-stand), and walking speed was evaluated. Subsequently, relative error (RE) between target and observed performance was computed for the submaximal tasks (RE50% and RE25%). Our results showed a decline of maximum performance after surgery, which resulted lower in patients compared to healthy subjects. RE50% and RE25% for knee extension (involved limb) (p < 0.001) and RE25% for sit-to-stand (p < 0.001) increased from pre- to postsurgery. At T0, knee extension RE25% and walking RE50% and RE25% were higher in patients. At T1, RE50% and RE25% were higher in patients for knee extension (involved limb), sit-to-stand, and walking. In conclusion, the ability to modulate motor and functional performance decreased after TKA and resulted impaired when compared to healthy age-matched subjects. Based on relationship between ability to modulate motor outputs and risk of falling, the role of modulation ability as indicator of readiness for discharge and safe return to daily activities deserves further investigations in patients in early phase after TKA.


Assuntos
Artroplastia do Joelho , Artroplastia do Joelho/métodos , Humanos , Articulação do Joelho/cirurgia , Desempenho Físico Funcional , Estudos Prospectivos , Caminhada
8.
Clin Orthop Surg ; 14(3): 361-369, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36061849

RESUMO

Background: Patellar resurfacing is performed in total knee arthroplasty (TKA) to improve pain in the anterior compartment of the knee joint and to restore proper coordination and movement of the patellofemoral joint. The purpose of this study was to analyze differences in clinical outcomes according to patellar resurfacing in patients who underwent bilateral TKA. Methods: Forty-three patients who underwent bilateral primary TKA with patellar resurfacing on one side only were included. Patellar resurfacing was performed selectively according to the status of the patella cartilage surface. Knee Society score (knee and function), Feller score, Kujala score, and Samsung Medical Center (SMC) score (pain and function) were evaluated. Results: There were no significant differences in Knee Society pain and function scores, Feller score, Kujala score, and SMC pain and function scores according to patellar resurfacing. On the comparison of SMC scores, there was no difference except for two questions. Conclusions: It is advisable not to perform resurfacing on normal patellae. However, in order to apply this result to damaged patellae, comparative studies between resurfaced patellae and damaged patellae are needed.


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgia , Dor/cirurgia , Patela/cirurgia
9.
Bone Joint J ; 104-B(9): 1060-1066, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36047015

RESUMO

AIMS: The aim of this study was to estimate the 90-day periprosthetic joint infection (PJI) rates following total knee arthroplasty (TKA) and total hip arthroplasty (THA) for osteoarthritis (OA). METHODS: This was a data linkage study using the New South Wales (NSW) Admitted Patient Data Collection (APDC) and the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), which collect data from all public and private hospitals in NSW, Australia. Patients who underwent a TKA or THA for OA between 1 January 2002 and 31 December 2017 were included. The main outcome measures were 90-day incidence rates of hospital readmission for: revision arthroplasty for PJI as recorded in the AOANJRR; conservative definition of PJI, defined by T84.5, the PJI diagnosis code in the APDC; and extended definition of PJI, defined by the presence of either T84.5, or combinations of diagnosis and procedure code groups derived from recursive binary partitioning in the APDC. RESULTS: The mean 90-day revision rate for infection was 0.1% (0.1% to 0.2%) for TKA and 0.3% (0.1% to 0.5%) for THA. The mean 90-day PJI rates defined by T84.5 were 1.3% (1.1% to 1.7%) for TKA and 1.1% (0.8% to 1.3%) for THA. The mean 90-day PJI rates using the extended definition were 1.9% (1.5% to 2.2%) and 1.5% (1.3% to 1.7%) following TKA and THA, respectively. CONCLUSION: When reporting the revision arthroplasty for infection, the AOANJRR substantially underestimates the rate of PJI at 90 days. Using combinations of infection codes and PJI-related surgical procedure codes in linked hospital administrative databases could be an alternative way to monitor PJI rates.Cite this article: Bone Joint J 2022;104-B(9):1060-1066.


Assuntos
Artrite Infecciosa , Artroplastia de Quadril , Artroplastia do Joelho , Osteoartrite , Infecções Relacionadas à Prótese , Artrite Infecciosa/diagnóstico , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Austrália/epidemiologia , Humanos , Incidência , Osteoartrite/cirurgia , Infecções Relacionadas à Prótese/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Sistema de Registros , Reoperação , Estudos Retrospectivos
10.
Bone Joint J ; 104-B(9): 1052-1059, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36047019

RESUMO

AIMS: Our main aim was to describe the trend in the comorbidities of patients undergoing elective total hip arthroplasties (THAs) and knee arthroplasties (KAs) between 1 January 2005 and 31 December 2018 in England. METHODS: We combined data from the National Joint Registry (NJR) on primary elective hip and knee arthroplasties performed between 2005 and 2018 with pre-existing conditions recorded at the time of their primary operation from Hospital Episodes Statistics. We described the temporal trend in the number of comorbidities identified using the Charlson Comorbidity Index, and how this varied by age, sex, American Society of Anesthesiologists (ASA) grade, index of multiple deprivation, and type of KA. RESULTS: We included 696,504 and 833,745 elective primary THAs and KAs respectively, performed for any indication. Between 2005 and 2018, the proportion of elective THA and KA patients with one or more comorbidity at the time of their operation increased substantially (THA: 20% to 38%, KA: 22% to 41%). This was driven by increases in four conditions: chronic obstructive pulmonary disease (COPD) (2018: ~17%), diabetes without complications (2018: THA 10%, KA 14%), myocardial infarction (2018: 4%), and renal disease (2018: ~8%). Notably, renal disease prevalence increased from < 1% in 2005 to ~8% in 2018. CONCLUSION: Between 2005 and 2018 there were significant changes in the number of comorbidities recorded in patients having elective primary THAs and KAs. Renal disease is now one of the most prevalent comorbidities in this patient population. Future research should explore whether this comorbidity trend has increased the burden on other medical specialities to optimize these patients before surgery and to provide additional postoperative care.Cite this article: Bone Joint J 2022;104-B(9):1052-1059.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Adulto , Estudos de Coortes , Comorbidade , Inglaterra/epidemiologia , Humanos , Sistema de Registros
11.
Anesthesiol Clin ; 40(3): 455-468, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36049874

RESUMO

Perioperative pain management is one of the domains in which Anesthesiologists are intricately involved, and which is immensely important. Adequate postoperative analgesia is central to avoid both the acute as well as chronic complications of uncontrolled postoperative pain. Preventive analgesia has been identified as an approach to mitigate the phenomenon of central sensitization, which plays an important role in the development of chronic pain after surgery. As an over-reliance on opioids for peri- and postoperative pain control is associated with opioid dependence and hyperalgesia, multimodal analgesia has taken center stage. Multimodal analgesia, in theory, will optimize perioperative pain control, reduce the chance of central sensitization, and avoid the detrimental effects of opioid overuse. Multiple classes of systemic analgesic medications have been used to accomplish these tasks, and the aim of this article is to outline these medications, their mechanisms of action, as well as the evidence behind their individual roles in multimodal analgesia. Regional anesthesia has also been embraced as a key component of multimodal analgesia in orthopedic surgery; however, over the past several years, local infiltration analgesia (LIA) emerged as a viable alternative, particularly in total knee arthroplasty.


Assuntos
Analgesia , Artroplastia do Joelho , Analgésicos Opioides/uso terapêutico , Anestésicos Locais , Humanos , Manejo da Dor , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia
12.
Anesthesiol Clin ; 40(3): 537-545, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36049880

RESUMO

Joint replacements are increasingly performed as outpatient surgeries. The push toward ambulatory joint arthroplasty is driven in part by the changing current health care economics and reimbursement models. Patients' selection and well-designed perioperative care pathways are critical for the success of these procedures. The rate of complications after outpatient joint arthroplasty is comparable to the rate of complications in the ambulatory setting. Patient education, adequate social support, multimodal analgesia, regional anesthesia are key ingredients to the ambulatory care pathway after joint arthroplasty. Motor sparing nerve blocks are often used in these settings. Implementation of the elements of fast protocols can result in overall improvement of outcome metrics for all patients undergoing joint arthroplasty, including reduced length of stay and increased rate of home discharge.


Assuntos
Analgesia , Artroplastia de Quadril , Artroplastia do Joelho , Artroplastia de Substituição , Procedimentos Cirúrgicos Ambulatórios , Analgesia/métodos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Humanos , Tempo de Internação , Alta do Paciente , Seleção de Pacientes
13.
Syst Rev ; 11(1): 184, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36050795

RESUMO

BACKGROUND: Total knee replacement (TKR) is a common operation typically performed for end-stage knee osteoarthritis. Patients awaiting TKR often have poor health-related quality of life. Approximately 20% of patients experience persistent pain post-TKR. Pre-operative TKR interventions could improve pre- and post-operative outcomes, but future research is required to inform their design. This review aimed to identify and synthesize recent literature on the content and delivery of pre-operative TKR interventions to help guide future research and clinical practice. METHODS: This rapid review included randomized trials of pre-operative TKR interventions ("outcomes studies") and primary studies exploring patients' and/or health professionals' views of pre-operative TKR interventions ("views studies"). Medline, Embase, PsycINFO, CINAHL and the Cochrane Central Register of Controlled Trials were searched for English language studies published between January 2009 and December 2020. Eligible studies' reference lists were screened. Studies were appraised using the Mixed Methods Appraisal Tool. The findings were narratively synthesized using a convergent segregated approach. RESULTS: From 3263 records identified, 52 studies were included (29 outcomes studies, 21 views studies, two outcomes/views studies). The studies' methodological quality varied but was generally highest in qualitative studies. The outcomes studies investigated education (n=5), exercise (n=20), psychological (n=2), lifestyle (n=1), and/or other interventions (n=5). The views studies addressed education (n=20), exercise (n=3), psychological (n=1), lifestyle (n=4), and/or other interventions (n=1). Only three outcomes studies (two randomized controlled trials (RCTs) and a pilot study) compared the effectiveness of intervention components/delivery approaches. The two RCTs' results suggest that pre-operative TKR exercise interventions are equally effective regardless of whether they include strength or strength plus balance training and whether they are hospital- or home-based. Personal tailoring and using more than one delivery format were associated with improved outcomes and/or perceived as beneficial for multiple intervention types. CONCLUSIONS: Definitive evidence on the optimal design of pre-operative TKR interventions is lacking. Personal tailoring and employing multiple delivery formats appear to be valuable design elements. Preliminary evidence suggests that including balance training and hospital versus home delivery may not be critical design elements for pre-operative TKR exercise interventions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42019143248 FUNDER: National Institute for Health and Care Research (ICA-CDRF-2018-04-ST2-006).


Assuntos
Artroplastia do Joelho , Osteoartrite do Joelho , Humanos , Osteoartrite do Joelho/cirurgia , Dor , Cuidados Pré-Operatórios , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
14.
JBJS Case Connect ; 12(3)2022 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-36075022

RESUMO

CASE: This report describes a histoplasma capsulatum total knee prosthetic joint infection (PJI) in an immunosuppressed patient treated with a 2-stage revision. The diagnosis of PJI was made based on minor criteria, and the causative organism was identified from cultures obtained at the time of explantation. The patient underwent induction with amphotericin B, followed by oral antifungal therapy and a successful 2-stage revision with a hinged prosthesis with an interval of ∼7 months between stage 1 and stage 2. At the most recent follow-up (18 months), she remained clear from infection with planned lifetime antifungal suppression. CONCLUSION: This case report highlights the importance of consideration of atypical organisms when treating immunocompromised patients. Furthermore, this case report documents one of the few cases of histoplasma PJI and provides a successful treatment algorithm to potentially be applied to future cases.


Assuntos
Artrite Infecciosa , Artroplastia do Joelho , Prótese do Joelho , Infecções Relacionadas à Prótese , Antifúngicos/uso terapêutico , Artrite Infecciosa/cirurgia , Artroplastia do Joelho/efeitos adversos , Feminino , Histoplasma , Humanos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/cirurgia , Reoperação/efeitos adversos
15.
BMC Anesthesiol ; 22(1): 290, 2022 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-36104664

RESUMO

BACKGROUND: Obstructive sleep apnea (OSA) is associated with neurocognitive impairment - a known risk factor for postoperative delirium. However, it is unclear whether OSA increases the risk of postoperative delirium and whether treatment is protective. The objectives of this study were to identify OSA with a home sleep apnea test (HSAT) and to determine whether auto-titrating positive airway pressure (APAP) reduces postoperative delirium in older adults with newly diagnosed OSA undergoing elective hip or knee arthroplasty. METHODS: We conducted a multi-centre, randomized controlled trial at three academic hospitals in Canada. Research ethics board approval was obtained from the participating sites and informed consent was obtained from participants. Inclusion criteria were patients who were [Formula: see text]0 years and scheduled for elective hip or knee replacement. Patients with a STOP-Bang score of ≥ 3 had a HSAT. Patients were defined as having OSA if the apnea-hypopnea index was ≥ 10/h. These patients were randomized 1:1 to either: 1) APAP for 72 h postoperatively or until discharge, or 2) routine care after surgery. The primary outcome was postoperative delirium, assessed twice daily with the Confusion Assessment Method for 72 h or until discharge or by chart review. The secondary outcome measures included length of stay, and perioperative complications occurring within 30 days after surgery. RESULTS: Of 549 recruited patients, 474 completed a HSAT. A total of 234 patients with newly diagnosed OSA were randomized. The mean age was 68.2 (6.2) years and 58.6% were male. Analysis was performed on 220 patients. In total, 2.7% (6/220) patients developed delirium after surgery: 4.4% (5/114) patients in the routine care group, and 0.9% (1/106) patients in the treatment group (P = 0.21). The mean length of stay for the APAP vs. the routine care group was 2.9 (2.9) days vs. 3.5 (4.5) days (P = 0.24). On postoperative night 1, 53.5% of patients used APAP for 4 h/night or more, this decreased to 43.5% on night 2, and 24.6% on night 3. There was no difference in intraoperative and postoperative complications between the two groups. CONCLUSIONS: We had an unexpectedly low rate of postoperative delirium thus we were unable to determine if postoperative delirium was reduced in older adults with newly diagnosed OSA receiving APAP vs. those who did not receive APAP after elective knee or hip arthroplasty. TRIAL REGISTRATION: This trial was retrospectively registered in clinicaltrials.gov NCT02954224 on 03/11/2016.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Delírio , Síndromes da Apneia do Sono , Apneia Obstrutiva do Sono , Acetaminofen , Idoso , Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Delírio/epidemiologia , Delírio/etiologia , Delírio/prevenção & controle , Feminino , Humanos , Masculino , Apneia Obstrutiva do Sono/complicações
16.
Medicine (Baltimore) ; 101(35): e30105, 2022 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-36107525

RESUMO

Total knee replacement (TKR) is associated with a large amount of bleeding; therefore, the prevalence of postoperative anemia is high. In particular, patients with chronic kidney disease (CKD) are more vulnerable to postoperative anemia than are healthy individuals. Accordingly, the effect of intraoperative intravenous ferric derisomaltose (FDI) supplementation on postoperative anemia and blood transfusion volume reduction in patients with CKD was studied. Patients who underwent unilateral TKR between January 2019 and December 2020 were retrospectively reviewed. In analyzing the data, the patients fell into the CKD group (n = 85) and the non-CKD group (n = 106). Each group was divided into a group using FDI and a non-FDI group, and classified into 4 groups. The postoperative hemoglobin level for each postoperative day (POD) was determined as the primary outcome. In addition, the patient transfusion rate, volume of transfusion, and length of hospital stay were set as secondary study outcomes during the period from surgery to discharge. There was no statistically significant difference in hemoglobin levels on PODs 0, 1, 2, 7, and 14 in the CKD group. In the CKD group, the transfusion volume of the FDI group was 0.58 ± 0.91 units per person, which was statistically significantly lower than 1.28 ± 1.28 units of the non-FDI group (P = .01). In the CKD group, the transfusion rate of the FDI group was 30.2%, which was statistically significantly lower than that of the non-FDI group, which was 56.3% (P = .02). This study showed that intravenous FDI supplementation after TKR in CKD patients did not reduce postoperative anemia but was an effective and safe treatment to reduce transfusion volume and transfusion rate. There was no statistically significant difference in hemoglobin levels on POD 0, 1, 2, 7, and 14 in the non-CKD group. In the non-CKD group, the transfusion volume of the FDI group was 0.46 ± 0.88 units per person, which was lower than the 0.56 ± 0.91 units of the non-FDI group, but it was not statistically significant (P = .59). In the non-CKD group, the transfusion rate of the FDI group was 23.0%, which was lower than that of the non-FDI group, which was 31.3%, but it was not statistically significant (P = .37).


Assuntos
Anemia , Artroplastia do Joelho , Insuficiência Renal Crônica , Anemia/complicações , Anemia/epidemiologia , Anemia/terapia , Artroplastia do Joelho/efeitos adversos , Transfusão de Sangue , Suplementos Nutricionais , Dissacarídeos , Compostos Férricos , Hemoglobinas/análise , Humanos , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/terapia , Estudos Retrospectivos
17.
ANZ J Surg ; 92(9): 2261-2268, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36097420

RESUMO

BACKGROUND: To determine the prevalence of opioid use in Australian hip (THA) or knee (TKA) cohort, and its association with outcomes. METHODS: About 837 primary THA or TKA subjects prospectively completed Oxford Scores, and Knee or Hip Osteoarthritis Outcomes Score(KOOS/HOOS) and opioid use in the previous week before arthroplasty. Subjects repeated the baseline survey at 6 months, with additional questions regarding satisfaction. RESULTS: Opioid use was reported by 19% preoperatively and 7% at 6 months. Opioid use was 46% at 6 weeks and 10% at 6 months after TKR, and 16% at 6 weeks and 4% at 6 months after THR. Preoperative opioid use was associated with back pain(OR 2.2, P = 0.006), anxiety or depression(OR 1.8, P = 0.001) and Oxford knee scores <30(OR 5.6, P = 0.021) in TKA subjects, and females in THA subjects(OR 1.7, P = 0.04). There was no difference between preoperative opioid users and non-users for satisfaction, or KOOS or HOOS scores at 6 months. 77% of patients taking opioids before surgery had ceased by 6 months, and 3% of preoperative non users reported opioid use at 6 months. Opioid use at 6 months was associated with preoperative use (OR 6.6-14.7, P < 0.001), and lower 6 month oxford scores (OR 4.4-83.6, P < 0.01). CONCLUSION: One in five used opioids before arthroplasty. Pre-operative opioid use was the strongest risk factor for opioid use at 6 months, increasing odds 7-15 times. Prolonged opioid use was rarely observed in the opioid naïve (<5% TKA and 1% THA). Preoperative opioid use was not associated with inferior outcomes or satisfaction.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Transtornos Relacionados ao Uso de Opioides , Analgésicos Opioides/uso terapêutico , Austrália/epidemiologia , Feminino , Humanos
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(9): 1098-1102, 2022 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-36111471

RESUMO

Objective: To compare the short-term effectiveness of medial unicompartmental knee arthroplasty (UKA) between patients younger or older than 60 years of age, and to investigate the impact of age on the effectiveness. Methods: The clinical data of 182 patients (182 knees) who underwent medial UKA between July 2016 and June 2018 were retrospectively analyzed, of which 72 patients were less than 60 years old (group A) and 110 patients were more than 60 years old (group B). There was a significant difference in age between groups (t=-20.198, P<0.001). No significant difference was found in gender, body mass index, surgical sides, Kellgren-Lawrence grading, disease duration, and preoperative Western Ontario and McMaster University Osteoarthritis Index (WOMAC) score between groups (P>0.05). The postoperative hospital stay and complications were recorded, and the WOMAC score, satisfaction score, and prosthesis revision were compared between groups. Results: The length of postoperative hospital stay was (4.50±1.09) days in group A, and (4.46±1.29) days in group B, with no significant difference between groups (t=0.198, P=0.844). All incisions healed by first intention. The incidences of early postoperative complications in groups A and B were 5.6% and 3.6%, respectively, and the difference was not significant (χ2=0.061, P=0.804). All patients were followed up. The follow-up time were 28-50 months (mean, 36 months) in group A and 28-50 months (mean, 35 months) in group B. At last follow-up, the WOMAC scores of both groups significantly improved when compared with those before operation (P<0.05), and there was no significant difference between groups (P>0.05) in the difference before and after operation. The satisfaction scores were 6.6±1.7 in group A and 6.9±1.6 in group B, with no significant difference between groups (t=-1.326, P=0.186). There was no revision surgery in both groups during follow-up period. Conclusion: Age has no significant effect on the prognosis of medial UKA, and patients younger than 60 years of age can also obtain good short-term effectiveness.


Assuntos
Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Artroplastia do Joelho/efeitos adversos , Humanos , Articulação do Joelho/cirurgia , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
20.
J Orthop Surg (Hong Kong) ; 30(3): 10225536221127460, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36120741

RESUMO

INTRODUCTION: Total knee arthroplasty is a common operation performed to relieve pain and restore functional activity. While overall widely successful, a subset of patients has continued pain postoperatively with no identifiable cause. Neuroma formation has been identified as a possible contributor to this unexplained pain, often necessitating an additional procedure for neuroma removal. The purpose of our study was to evaluate if prophylactic neurectomy could reduce the occurrence of postoperative pain. METHODS: A total of 112 patients were compared, 44 control patients and 68 neurectomy patients. Demographic information, Numerical rating pain scale (NRS) and Knee Society Scores (KSS) were collected pre- and post-operatively. Patients were additional asked if they were overall satisfied with the operation. RESULTS: There were no differences between groups with respect to age (Median: 71 vs 69 years, p = 0.28), male sex (41% vs 44%, p = 0.85), or body mass index (Median: 32.2 vs 31.3, p = 0.80). When comparing the degree of change following surgery there were no statistically significant differences observed in NRS pain scores (Median change: -7 vs -6, p = 0.89) or KSS scores (Median change: +44 vs +40, p = 0.14). Similarly, there was no statistically significant difference in overall patient-reported satisfaction with the knee replacement (82.5% vs 86.6%, p = 0.59). CONCLUSION: We did not find a statistically significant difference in NRS, KSS, or overall patient satisfaction between the prophylactic neurectomy and control patient groups. Larger studies with evaluation of the nerve diameter will be needed to determine which patients are at risk for symptomatic neuroma development following total knee arthroplasty.


Assuntos
Artroplastia do Joelho , Neuroma , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Denervação/efeitos adversos , Humanos , Masculino , Neuroma/complicações , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Estudos Retrospectivos
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