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1.
Medicine (Baltimore) ; 99(41): e22494, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031285

RESUMO

INTRODUCTION: Sneathia sanguinegens(S sanguinegens) is a gram-negative rod-shaped bacterium mostly reported to cause a perinatal infection, and there are no reports of S sanguinegens in prosthetic joint infection (PJI). The purpose of this report is to describe a very rare case of PJI after total hip arthroplasty (THA) caused by S sanguinegens. PATIENT CONCERNS: A 79-year-old woman presented with right coxalgia, inability to walk, and a fever of 39°C. She had undergone THA 28 years earlier for osteoarthritis of the hip. DIAGNOSES: The diagnosis was acute late-onset PJI, because blood tests revealed marked inflammatory reaction and computed tomography showed an abscess at the right hip joint; synovial fluid analysis resulted in detection of a gram-negative bacillus. INTERVENTION: Surgical debridement with retention of the implant and antibiotic therapy was performed. OUTCOMES: One month after surgery, polymerase chain reaction (PCR) assay showed that the pathogen was 99.9% likely to be S sanguinegens. There has been no recurrence of infection or loosening of the implant in the 2 years since her surgery. LESSONS: PCR should facilitate detection of previously unknown pathogens and potentially novel bacterial species.


Assuntos
Fusobactérias , Infecções por Bactérias Gram-Negativas/complicações , Infecções Relacionadas à Prótese/microbiologia , Idoso , Antibacterianos/uso terapêutico , Artroplastia de Quadril , Feminino , Fusobactérias/isolamento & purificação , Infecções por Bactérias Gram-Negativas/diagnóstico , Humanos , Reação em Cadeia da Polimerase , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/cirurgia
2.
AJR Am J Roentgenol ; 215(3): 568-581, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32783556

RESUMO

OBJECTIVE. The purpose of this evidence-based review is to equip radiologists to discuss and interpret findings obtained with various imaging modalities, guide patient selection for percutaneous aspiration, and safely perform arthrocentesis to assess for infection in both native and prosthetic joints. CONCLUSION. Septic arthritis is an emergency that can lead to rapidly progressive, irreversible joint damage. Despite the urgency associated with this diagnosis, there remains a lack of consensus regarding many aspects of the management of native and periprosthetic joint infections.


Assuntos
Artrite Infecciosa/diagnóstico por imagem , Artrite Infecciosa/cirurgia , Artrocentese , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Artrite Infecciosa/microbiologia , Meios de Contraste , Diagnóstico Diferencial , Humanos , Seleção de Pacientes , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Fatores de Risco , Líquido Sinovial/microbiologia
3.
Bone Joint J ; 102-B(8): 997-1002, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731820

RESUMO

AIMS: The aim of this study was to investigate whether the use of antibiotic-loaded bone cement influenced the risk of revision surgery after primary total hip arthroplasty (THA) for osteoarthritis. METHODS: The study involved data collected by the National Joint Registry (NJR) for England and Wales, Northern Ireland and the Isle of Man between 1 September 2005 and 31 August 2017. Cox proportional hazards were used to investigate the association between use of antibiotic-loaded bone cement and the risk of revision due to prosthetic joint infection (PJI), with adjustments made for the year of the initial procedure, age at the time of surgery, sex, American Society of Anesthesiologists (ASA) grade, head size, and body mass index (BMI). We looked also at the association between use of antibiotic-loaded bone cement and the risk of revision due to aseptic loosening or osteolysis. RESULTS: The cohort included 418,857 THAs of whom 397,896 had received antibiotic-loaded bone cement and 20,961 plain cement. After adjusting for putative confounding factors, the risk of revision for PJI was lower in those in whom antibiotic-loaded bone cement was used (hazard ration (HR) 0.79; 95% confidence interval (CI) 0.64 to 0.98). There was also a protective effect on the risk of revision due to aseptic loosening or osteolysis, in the period of > 4.1 years after primary THA, HR 0.57, 95% CI 0.45, 0.72. CONCLUSION: Within the limits of registry analysis, this study showed an association between the use of antibiotic-loaded bone cement and lower rates of revision due to PJI. The findings support the continued use of antibiotic-loaded bone cement in cemented THA. Cite this article: Bone Joint J 2020;102-B(8):997-1002.


Assuntos
Antibacterianos/farmacologia , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Cimentos para Ossos/farmacologia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Adulto , Idoso , Inglaterra , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Irlanda do Norte , Osteoartrite do Quadril/cirurgia , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Sistema de Registros , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , País de Gales
4.
Acta Chir Orthop Traumatol Cech ; 87(3): 175-182, 2020.
Artigo em Tcheco | MEDLINE | ID: mdl-32773018

RESUMO

PURPOSE OF THE STUDY Periprosthetic joint infections in total knee arthroplasty (TKA) represent one of the most limiting factors of implantation. Frequency of this complication is up to 2.5% in primary implantation. Revision TKA with the use of DAIR (Debridement, Antibiotics and Implant Retention) procedure is a widely accepted method in treating infection, but the indication criteria have not been clearly defined as yet. The lack of uniformity prevails also with respect to the surgical technique and the importance of respective techniques for successful treatment. The purpose of this study was to evaluate the factors affecting the twoyear survival of TKA after treating the infection by DAIR. MATERIAL AND METHODS We conducted a monocentric retrospective analysis involving 52 cases of infected TKA managed with DAIR in the period between 2007 and 2016. The evaluation took into account such factors as the sex, age, history of revision surgery for aseptic or septic reasons, and pathogens. The patients were divided into groups based on the McPherson criteria. As to the procedure, we monitored the effect of administered antibiotics, time interval between the manifestation of symptoms of TKA infection and surgery, exchange of modular parts, and use of pulse lavage, continual lavage, local antibiotic carrier, or combination of these techniques. Treatment failure was defined as persistent infection and transition to chronic suppressive antibiotic therapy or need for revision surgery of the respective joint due to recurrent infection of TKA, or death directly associated with the treatment of infected TKA in the follow-up period of 2 years after DAIR. The R software (Team Development Core, 2017) was used to carry out the statistical analysis. The target variable was the failure at two years after surgery. The Generalized Linear Model (GLM) was used for the binary dependent variable - the socalled logistic model with a logit link function. RESULTS 32 of 52 patients (61.5%) were successfully treated, of whom 18 women (62.1%) and 14 men (60.9%). The effect of causative agent, administered antibiotics, polyethylene insert exchange, McPherson score or history of revision surgery of the respective joint for aseptic reasons was not confirmed. The history of revision surgery for infection of the affected joint had a strong negative impact on treatment success, 10 of 13 (76.9%) implants failed as against 10 of 39 (25.6%) implants with negative history of infection. The mean time from surgery to the manifestation of infection was 5.9 weeks (0.5-47.5). When surgery was performed within 2 weeks from the manifestation of infection, 1 of 15 (6.7%) cases failed. In case of a later surgery, 19 of 37 (51.4%) cases failed. As concerns the used surgical technique, 60% (9/15) failure was reported in case of the combination of pulse lavage and continual lavage, 36.4% (4/11) in case of the combination of pulse lavage and local antibiotic carrier, 25% (4/16) in case of separate continual lavage, and 66.7% (2/3) in case of continual lavage with local antibiotic carrier. DISCUSSION The importance of individual factors in revision surgery of periprosthetic joint infections of TKA remains unclear. The world literature indicates as a major negative effect the time factor, the positive history of infection of the affected implant, or other previous revision surgery for aseptic reasons. Ambiguous results are achieved in assessing the effect of the pathogen, administered antibiotics or presence of fistula, the statistical significance of which has not been confirmed in our study. Questionable is also the importance of individual surgical techniques. CONCLUSIONS DAIR is a suitable method in treating infections of stable TKA without the history of revision surgery for infection. The surgery should be performed within 2 weeks from the manifestation of symptoms. Key words: debridement, antibiotics, infection, implant retention, total knee arthroplasty.


Assuntos
Artroplastia do Joelho , Infecções Relacionadas à Prótese , Antibacterianos/uso terapêutico , Artroplastia do Joelho/efeitos adversos , Desbridamento , Feminino , Humanos , Masculino , Infecções Relacionadas à Prótese/cirurgia , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida
5.
J Card Surg ; 35(10): 2829-2831, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32678968

RESUMO

BACKGROUND: Surgery for failed homograft aortic root replacement with extensive calcification in the setting of endocarditis alone is very challenging. CASE SUMMARY: We report the case of redo aortic valve replacement and mitral valve replacement, in a 39 years old presenting with a rare Streptococcus constellatus endocarditis of a previously implanted homograft root and native mitral valve, where conventional valve replacement proved nonfeasible. S. constellatus had caused severe tissue destruction and the extensive calcification in the homograft prevented conventional valve replacement with sutures. In this case, a sutureless valve provided a useful alternative surgical strategy. DISCUSSION: We consider heavily calcified failed homografts to be a good indication for sutureless (rapid deployment) valves.


Assuntos
Valva Aórtica/cirurgia , Bioprótese/efeitos adversos , Endocardite Bacteriana/complicações , Implante de Prótese de Valva Cardíaca/métodos , Próteses Valvulares Cardíacas , Desenho de Prótese , Falha de Prótese/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Infecções Estreptocócicas/cirurgia , Streptococcus constellatus , Procedimentos Cirúrgicos sem Sutura/métodos , Adulto , Aloenxertos , Endocardite Bacteriana/microbiologia , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/microbiologia , Infecções Estreptocócicas/etiologia , Infecções Estreptocócicas/microbiologia , Resultado do Tratamento
6.
J Card Surg ; 35(10): 2857-2859, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32720391

RESUMO

BACKGROUND: Postoperative thoracic aortic graft infection (TAGI) is a serious and potentially fatal complication. The classical approach is to replace the infected graft. However, this approach has a high mortality rate. Alternatively, treatment of TAGI without graft replacement can be performed METHOD: Herein, we present a 72-year-old case with mediastinitis and graft infection after type A aortic dissection operation and successful treatment using omental flap coverage following vacuum-assisted wound closure therapy without graft replacement. CONCLUSION: The patient had an uneventful postoperative course and remains infection-free to date.


Assuntos
Aneurisma Dissecante/cirurgia , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/métodos , Tratamento de Ferimentos com Pressão Negativa/métodos , Omento/transplante , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Retalhos Cirúrgicos , Idoso , Feminino , Humanos , Resultado do Tratamento
7.
JBJS Case Connect ; 10(3): e2000226, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32668143

RESUMO

CASE: We report the case of a 64-year-old man who presented with a late onset of acute periprosthetic joint infection after total knee arthroplasty and a positive severe acute respiratory syndrome coronavirus 2 polymerase chain reaction test. We describe our perioperative protocol and challenges for ensuring the safety of healthcare providers while operating on a coronavirus disease 2019 (COVID-19)-positive patient. CONCLUSIONS: Given the incredible spread of COVID-19 globally, hospitals should anticipate perioperative protocols for the surgical management of COVID-19-positive patients with concurrent pathology to ensure safety to healthcare providers.


Assuntos
Artrite Infecciosa/cirurgia , Betacoronavirus , Infecções por Coronavirus , Controle de Infecções/métodos , Pandemias , Pneumonia Viral , Infecções Relacionadas à Prótese/cirurgia , Artrite Infecciosa/complicações , Humanos , Prótese do Joelho/efeitos adversos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/complicações
8.
Bone Joint J ; 102-B(7): 852-860, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600135

RESUMO

AIMS: Our objective is to describe our early and mid-term results with the use of a new simple primary knee prosthesis as an articulating spacer in planned two-stage management for infected knee arthroplasty. As a second objective, we compared outcomes between the group with a retained first stage and those with a complete two-stage revision. METHODS: We included 47 patients (48 knees) with positive criteria for infection, with a minimum two-year follow-up, in which a two-stage approach with an articulating spacer with new implants was used. Patients with infection control, and a stable and functional knee were allowed to retain the initial first-stage components. Outcomes recorded included: infection control rate, reoperations, final range of motion (ROM), and quality of life assessment (QoL) including Western Ontario and McMaster Universities osteoarthritis index, Knee Injury and Osteoarthritis Outcome Score, Oxford Knee Score, 12-Item Short-Form Health Survey questionnaire, and University of California Los Angeles (UCLA) activity score and satisfaction score. These outcomes were evaluated and compared to additional cohorts of patients with retained first-stage interventions and those with a complete two-stage revision. Mean follow-up was 3.7 years (2.0 to 6.5). RESULTS: Eight knees failed directly related to lack of infection control (16%), and two patients (two knees) died within the first year for causes not directly related, giving an initial success rate of 79% (38/48). Secondary success rate after a subsequent procedure was 91% (44/48 knees). From the initially retained spacers, four knees (22%) required a second-stage revision for continuous symptoms and one (5%) for an acute infection. There were no significant differences regarding the failure rate due to infection, ROM, and QoL assessment between patients with a retained first-stage procedure and those who underwent a second-stage operation. CONCLUSION: Our protocol of two-stage exchange for infected knee arthroplasties with an articulating spacer and using new primary knee implants achieves adequate infection control. Retained first-stage operations achieve comparable results in selected cases, with no difference in infection control, ROM, and QoL assessment in comparison to patients with completed two-stage revision surgery. Cite this article: Bone Joint J 2020;102-B(7):852-860.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Desenho de Prótese , Infecções Relacionadas à Prótese/cirurgia , Idoso , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Masculino , Satisfação do Paciente , Qualidade de Vida , Amplitude de Movimento Articular , Reoperação , Estudos Retrospectivos
9.
J Med Microbiol ; 69(8): 1100-1104, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32639225

RESUMO

Introduction. Periprosthetic joint infections caused by methicillin-resistant Staphylococcus aureus (MRSA-PJIs) are rare, with only a few studies reporting the treatment outcomes and even fewer reporting outcomes with one-stage exchange.Aim. This study aims to analyse the outcomes of one-stage exchange in the management of MRSA-PJIs.Methodology. Patients with MRSA-PJI of the hip and knee, who were treated with a one-stage exchange between 2001 and 2018 were enrolled in this study. The final cohort comprised of 29 patients, which included 23 hips and six knees. The mean follow-up was 5.3 years (1-9 years). Reinfection and complications rates after the one-stage exchange were analysed.Results. Overall infection control could be achieved in 93.1 % (27 out of 29 patients). The overall revision rate was 31.0% (9 patients), with three patients requiring an in-hospital revision (10.3 %). Six patients had to be revised after hospital discharge (20.7 %). Of the two reinfections, one had a growth of MRSA while the other was of methicillin-sensitive Staphyloccocus epidermidis.Conclusion. One-stage exchange surgery using current techniques could improve surgical outcomes with excellent results in the management of MRSA-PJIs.


Assuntos
Artrite Infecciosa/terapia , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Staphylococcus aureus Resistente à Meticilina , Infecções Relacionadas à Prótese/terapia , Infecções Estafilocócicas/terapia , Adulto , Assistência ao Convalescente , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Artrite Infecciosa/cirurgia , Estudos de Coortes , Desbridamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/cirurgia , Recidiva , Reoperação , Estudos Retrospectivos , Infecções Estafilocócicas/cirurgia , Fatores de Tempo , Resultado do Tratamento
10.
Eur Heart J ; 41(22): 2092-2112, 2020 06 07.
Artigo em Inglês | MEDLINE | ID: covidwho-574867

RESUMO

The COVID-19 pandemic has greatly impacted the daily clinical practice of cardiologists and cardiovascular surgeons. Preparedness of health workers and health services is crucial to tackle the enormous challenge posed by SARS-CoV-2 in wards, operating theatres, intensive care units, and interventionist laboratories. This Clinical Review provides an overview of COVID-19 and focuses on relevant aspects on prevention and management for specialists within the cardiovascular field.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Endocardite/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Infecções Relacionadas à Prótese/cirurgia
11.
J Med Vasc ; 45(4): 177-183, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32571557

RESUMO

OBJECTIVE: To evaluate the short and long-term results of in situ prosthetic graft treatment using rifampicin-soaked silver polyester graft in patients with aortic infection. MATERIAL AND METHOD: All the patients surgically managed in our center for an aortic infection were retrospectively analyzed. The primary endpoint was the intra-hospital mortality, secondary outcomes were limb salvage, persistent or recurrent infection, prosthetic graft patency, and long-term survival. RESULTS: From January 2004 to December 2015, 18 consecutive patients (12 men and 6 women) were operated on for aortic infection. Six mycotic aneurysms and 12 prosthetic infections, including 8 para-entero-prosthetic fistulas, were treated. In 5 cases, surgery was performed in emergency. During the early postoperative period, we performed one major amputation and two aortic infections were persistent. Intra-hospital mortality was 27.7%. The median follow-up among the 13 surviving patients was 26 months. During follow-up, none of the 13 patients presented reinfection or bypass thrombosis. CONCLUSION: This series shows that in situ revascularization with rifampicin-soaked silver polyester graft for aortic infection have results in agreement with the literature in terms of intra-hospital mortality with a low reinfection rate.


Assuntos
Aneurisma Infectado/cirurgia , Antibacterianos/administração & dosagem , Aneurisma Aórtico/cirurgia , Implante de Prótese Vascular/instrumentação , Prótese Vascular , Poliésteres , Infecções Relacionadas à Prótese/cirurgia , Rifampina/administração & dosagem , Prata , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Aneurisma Infectado/diagnóstico por imagem , Aneurisma Infectado/microbiologia , Aneurisma Infectado/mortalidade , Antibacterianos/efeitos adversos , Aneurisma Aórtico/diagnóstico por imagem , Aneurisma Aórtico/microbiologia , Aneurisma Aórtico/mortalidade , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/mortalidade , Feminino , França , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Poliésteres/efeitos adversos , Desenho de Prótese , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/mortalidade , Estudos Retrospectivos , Rifampina/efeitos adversos , Fatores de Risco , Prata/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Bone Joint J ; 102-B(6_Supple_A): 170-175, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475264

RESUMO

AIMS: Arthrodesis is rarely used as a salvage procedure for patients with a chronically infected total knee arthroplasty (TKA), and little information is available about the outcome. The aim of this study was to assess the reliability, durability, and safety of this procedure as the definitive treatment for complex, chronically infected TKA, in a current series of patients. METHODS: We retrospectively identified 41 patients (41 TKAs) with a complex infected TKA, who were treated between 2002 and 2016 using a deliberate, two-stage knee arthrodesis. Their mean age was 64 years (34 to 88) and their mean body mass index (BMI) was 39 kg/m2 (25 to 79). The mean follow-up was four years (2 to 9). The extensor mechanism (EM) was deficient in 27 patients (66%) and flap cover was required in 14 (34%). Most patients were host grade B (56%) or C (29%), and limb grade 3 (71%), according to the classification of McPherson et al. A total of 12 patients (29%) had polymicrobial infections and 20 (49%) had multi-drug resistant organisms; fixation involved an intramedullary nail in 25 (61%), an external fixator in ten (24%), and dual plates in six (15%). RESULTS: Survivorship free from amputation, persistent infection, and reoperation, other than removal of an external fixator, at five years was 95% (95% confidence interval (CI) 89% to 100%), 85% (95% CI 75% to 95%), and 64% (95% CI 46% to 82%), respectively. Reoperation, other than removal of an external fixator, occurred in 13 patients (32%). After the initial treatment, radiological nonunion developed in ten knees (24%). Nonunion was significantly correlated with persistent infection (p = 0.006) and external fixation (p = 0.005). Of those patients who achieved limb salvage, 34 (87%) remained mobile and 31 (79%) had 'absent' or 'minimal' pain ratings. CONCLUSION: Knee arthrodesis using a two-stage protocol achieved a survivorship free from amputation for persistent infection of 95% at five years with 87% of patients were mobile at final follow-up. However, early reoperation was common (32%). This is not surprising as this series included worst-case infected TKAs in which two-thirds of the patients had a disrupted EM, one-third required flap cover, and most had polymicrobial or multi-drug resistant organisms. Cite this article: Bone Joint J 2020;102-B(6 Supple A):170-175.


Assuntos
Artrodese/métodos , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artrodese/efeitos adversos , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Estudos Retrospectivos
13.
Bone Joint J ; 102-B(6_Supple_A): 176-180, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475267

RESUMO

AIMS: The integrity of the soft tissue envelope is crucial for successful treatment of infected total knee arthroplasty (TKA). The purpose of this study was to evaluate the rate of limb salvage, infection control, and clinical function following microvascular free flap coverage for salvage of the infected TKA. METHODS: We retrospectively reviewed 23 microvascular free tissue transfers for management of soft tissue defects in infected TKA. There were 16 men and seven women with a mean age of 61.2 years (39 to 81). The median number of procedures performed prior to soft tissue coverage was five (2 to 9) and all patients had failed at least one two-stage reimplantation procedure. Clinical outcomes were measured using the Knee Society Scoring system for pain and function. RESULTS: In all, one patient was lost to follow-up prior to 12 months. The remaining 22 patients were followed for a mean of 46 months (12 to 92). At latest follow-up, four patients (18%) had undergone amputation for failure of treatment and persistent infection. For the other 18 patients, 11 patients (50%) had maintained a knee prosthesis in place while seven patients had undergone resections for persistent infection but retained their limbs (32%). Reoperations were common following coverage and reimplantation. The median number of additional procedures was two (0 to 6). Clinical function was poor in patients who underwent reimplantation and retained a knee prosthesis following free flap coverage with a mean KSS score for pain and function of 44 (0 to 70) and 30 (0 to 65), respectively. All patients required an assistive device. Extensor mechanism problems and extensor lag requiring bracing were common following limb salvage and prosthesis reimplantation. CONCLUSION: Microvascular tissue transfer for management of infected TKA can be successful in limb salvage (82%) but clinical outcomes in salvaged limbs were poor. Cite this article: Bone Joint J 2020;102-B(6 Supple A):176-180.


Assuntos
Artroplastia do Joelho , Retalhos de Tecido Biológico/irrigação sanguínea , Prótese do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Terapia de Salvação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Microvasos , Pessoa de Meia-Idade , Estudos Retrospectivos
14.
Bone Joint J ; 102-B(6_Supple_A): 3-9, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475278

RESUMO

AIMS: The aim of this study was to determine if a three-month course of microorganism-directed oral antibiotics reduces the rate of failure due to further infection following two-stage revision for chronic prosthetic joint infection (PJI) of the hip and knee. METHODS: A total of 185 patients undergoing a two-stage revision in seven different centres were prospectively enrolled. Of these patients, 93 were randomized to receive microorganism-directed oral antibiotics for three months following reimplantation; 88 were randomized to receive no antibiotics, and four were withdrawn before randomization. Of the 181 randomized patients, 28 were lost to follow-up, six died before two years follow-up, and five with culture negative infections were excluded. The remaining 142 patients were followed for a mean of 3.3 years (2.0 to 7.6) with failure due to a further infection as the primary endpoint. Patients who were treated with antibiotics were also assessed for their adherence to the medication regime and for side effects to antibiotics. RESULTS: Nine of 72 patients (12.5%) who received antibiotics failed due to further infection compared with 20 of 70 patients (28.6%) who did not receive antibiotics (p = 0.012). Five patients (6.9%) in the treatment group experienced adverse effects related to the administered antibiotics severe enough to warrant discontinuation. CONCLUSION: This multicentre randomized controlled trial showed that a three-month course of microorganism-directed, oral antibiotics significantly reduced the rate of failure due to further infection following a two-stage revision of total hip or knee arthroplasty for chronic PJI. Cite this article: Bone Joint J 2020;102-B(6 Supple A):3-9.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Prótese de Quadril/efeitos adversos , Prótese do Joelho/efeitos adversos , Falha de Prótese , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação , Administração Oral , Idoso , Doença Crônica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Fatores de Tempo
15.
Bone Joint J ; 102-B(6_Supple_A): 145-150, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32475287

RESUMO

AIMS: Two-stage exchange arthroplasty is the most common definitive treatment for prosthetic joint infection (PJI) in the USA. Complications that occur during treatment are often not considered. The purpose of this study was to analyze complications in patients undergoing two-stage exchange for infected total knee arthroplasty (TKA) and determine when they occur. METHODS: We analyzed all patients that underwent two-stage exchange arthroplasty for treatment of PJI of the knee from January 2010 to December 2018 at a single institution. We categorized complications as medical versus surgical. The intervals for complications were divided into: interstage; early post-reimplantation (three months); and late post-reimplantation (three months to minimum one year). Minimum follow-up was one year. In total, 134 patients underwent a first stage of a two-stage exchange. There were 69 males and 65 females with an mean age at first stage surgery of 67 years (37 to 89). Success was based on the new Musculoskeletal Infection Society (MSIS) definition of success reporting. RESULTS: Overall, 70 (52%) patients experienced a complication during the planned two-stage treatment, 36 patients (27%) experienced a medical complication and 47 (41%) patients experienced a surgical complication. There was an 18% mortality rate (24/134) at a mean of 3.7 years (0.09 to 8.3). During the inter-stage period, 28% (37/134) of patients experienced a total of 50 complications at a median of 47 days (interquartile range (IQR) 18 to 139). Of these 50 complications, 22 were medical and 28 required surgery. During this inter-stage period, four patients died (3%) and an additional five patients (4%) failed to progress to the second stage. While 93% of patients (125/134) were reimplanted, only 56% (77/134) of the patients were successfully treated without antibiotic suppression (36%, 28/77) or with antibiotic suppression (19%, 15/77) at one year. CONCLUSION: Reported rates of success of two stage exchanges for PJI have not traditionally considered complications in the definition of success. In our series, significant numbers of patients experienced complications, more often after reimplantation, highlighting the morbidity of this method of treatment. Cite this article: Bone Joint J 2020;102-B(6 Supple A):145-150.


Assuntos
Artroplastia do Joelho/métodos , Complicações Intraoperatórias/epidemiologia , Prótese do Joelho/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
16.
J Card Surg ; 35(7): 1640-1641, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32485059

RESUMO

The migration of sternal wires into vital structures is a rare but potentially life-threatening complication and associated with infection in some cases. While a few cases have been reported the sternal wires were broken in those cases. To our knowledge, this is the first report of multiple, nonbroken, migrated sternal wires stabbing vascular grafts.


Assuntos
Prótese Vascular/efeitos adversos , Fios Ortopédicos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/cirurgia , Hemorragia/etiologia , Hemorragia/cirurgia , Falha de Prótese , Infecções Relacionadas à Prótese/cirurgia , Idoso , Feminino , Humanos , Infecções Relacionadas à Prótese/etiologia , Reoperação , Esternotomia , Esterno , Técnicas de Sutura , Fatores de Tempo
17.
Eur Heart J ; 41(22): 2092-2112, 2020 06 07.
Artigo em Inglês | MEDLINE | ID: mdl-32511724

RESUMO

The COVID-19 pandemic has greatly impacted the daily clinical practice of cardiologists and cardiovascular surgeons. Preparedness of health workers and health services is crucial to tackle the enormous challenge posed by SARS-CoV-2 in wards, operating theatres, intensive care units, and interventionist laboratories. This Clinical Review provides an overview of COVID-19 and focuses on relevant aspects on prevention and management for specialists within the cardiovascular field.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/transmissão , Endocardite/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/diagnóstico , Pneumonia Viral/transmissão , Infecções Relacionadas à Prótese/cirurgia
18.
J Card Surg ; 35(6): 1348-1350, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: covidwho-343637

RESUMO

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being considered in order to maximise resource utilisation. We present a case of a 69-year old lady with an infected prosthetic aortic valve for consideration of urgent inpatient surgery. Despite being asymptomatic and testing negative initially for COVID-19 RT-PCR swab, further investigations with CT revealed suspicious findings. She subsequently tested positive on a repeat swab and unfortunately deteriorated rapidly with complications including gastro-intestinal and intracerebral haemorrhage.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Pneumonia Viral/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/virologia , Tempo para o Tratamento , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico , Ecocardiografia Transesofagiana/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pandemias , Infecções Relacionadas à Prótese/diagnóstico por imagem , Radiografia Torácica/métodos , Reoperação/métodos , Tomografia Computadorizada por Raios X/métodos
19.
Ann Vasc Surg ; 68: 549-552, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32416312

RESUMO

BACKGROUND: The residual stump after excision of an infected aortic graft may be subject to acute disruption-blowout-because of recurrence of infection or fatigue due to the mechanical stress. We present an innovative technique in which we used the falciform ligament of the liver to reinforce the aortic stump. METHODS: We excised the falciform ligament by giving attention to avoid any bleeding from the liver. The aortic stump was reinforced with synthetic, monofilament, nonabsorbable polypropylene sutures and the falciform ligament of the liver was plicated inside the stump and further sutured with polypropylene sutures. RESULTS: After 5 months, he is in excellent condition. His laboratory examination is normal, he has stopped taking antibiotics, gained his initial weight, and recovered full activity. CONCLUSIONS: We presented an innovative technique in which we used the falciform ligament of the liver to reinforce the aortic stump after excision of an infected aortobiiliac synthetic graft. This technique can be an alternative option in patients with weak arterial wall or extended bacterial local infection in the retroperitoneal area which renders the aortic wall tissue extremely stiff to be folded and sutured. This technique may enhance the mechanical integrity of the stump.


Assuntos
Aorta Abdominal/cirurgia , Aneurisma da Aorta Abdominal/cirurgia , Implante de Prótese Vascular , Remoção de Dispositivo , Ligamentos/transplante , Infecções Relacionadas à Prótese/cirurgia , Técnicas de Sutura , Idoso , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Humanos , Fígado , Masculino , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/microbiologia , Resultado do Tratamento
20.
J Card Surg ; 35(6): 1348-1350, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32445276

RESUMO

The novel coronavirus, now termed SARS-CoV-2, has caused a significant global impact in the space of 4 months. Almost all elective cardiac surgical operations have been postponed with only urgent and emergency operations being considered in order to maximise resource utilisation. We present a case of a 69-year old lady with an infected prosthetic aortic valve for consideration of urgent inpatient surgery. Despite being asymptomatic and testing negative initially for COVID-19 RT-PCR swab, further investigations with CT revealed suspicious findings. She subsequently tested positive on a repeat swab and unfortunately deteriorated rapidly with complications including gastro-intestinal and intracerebral haemorrhage.


Assuntos
Betacoronavirus , Infecções por Coronavirus/diagnóstico , Implante de Prótese de Valva Cardíaca/efeitos adversos , Pneumonia Viral/diagnóstico , Infecções Relacionadas à Prótese/cirurgia , Infecções Relacionadas à Prótese/virologia , Tempo para o Tratamento , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Técnicas de Laboratório Clínico , Ecocardiografia Transesofagiana/métodos , Serviço Hospitalar de Emergência , Evolução Fatal , Feminino , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Pandemias , Infecções Relacionadas à Prótese/diagnóstico por imagem , Radiografia Torácica/métodos , Reoperação/métodos , Tomografia Computadorizada por Raios X/métodos
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