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1.
Plast Reconstr Surg ; 145(2): 317-327, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31985612

RESUMO

BACKGROUND: This study investigated the risk of reconstruction failure after mastectomy, immediate breast reconstruction, and radiotherapy to either a temporary tissue expander or permanent implant. METHODS: Records of women treated at a single institution between June of 1997 and December of 2011 were reviewed. Two patient groups were identified based on type of immediate breast reconstruction: tissue expander followed by exchange with a permanent implant and permanent implant. The study endpoint was rate of reconstruction failure, defined as a replacement, loss of the implant, or conversion to flap. RESULTS: The tissue expander/permanent implant and the permanent implant groups consisted of 63 and 75 patients, respectively. The groups were well balanced for clinical and treatment characteristics. With a median follow-up of 116 months, eight implant losses, 50 implant replacements, and four flap conversions were recorded. Reconstruction failure occurred in 22 of 63 patients in the expander/implant group and in 40 of 75 patients in the permanent implant group. A traditional proportional hazards model showed a higher risk of reconstruction failure for the expander/implant group (hazard ratio, 2.01) and a significantly shorter time to reconstruction failure compared with the permanent implant group (109.2 months versus 157.7 months; p = 0.03); however, according to a competing risk model, the between-groups cumulative incidences were not significantly different (hazard ratio, 1.09). CONCLUSIONS: Radiotherapy to either a tissue expander or a permanent implant presented a fairly large risk of reconstruction failure over time. The expander/implant group was not more likely to develop reconstruction failure compared to permanent implant group, but the timing of onset was shorter. More complex techniques should be investigated to lower the risk of reconstruction failure. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Neoplasias da Mama/cirurgia , Mastectomia/métodos , Expansão de Tecido/métodos , Adolescente , Adulto , Idoso , Antibacterianos/administração & dosagem , Implante Mamário/instrumentação , Implante Mamário/métodos , Neoplasias da Mama/radioterapia , Implantes de Medicamento , Feminino , Humanos , Mamoplastia/métodos , Pessoa de Meia-Idade , Polimetil Metacrilato/uso terapêutico , Cuidados Pós-Operatórios/métodos , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Terapia de Salvação/instrumentação , Terapia de Salvação/métodos , Expansão de Tecido/instrumentação , Dispositivos para Expansão de Tecidos , Resultado do Tratamento , Adulto Jovem
2.
Vasc Endovascular Surg ; 54(2): 147-161, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31736431

RESUMO

INTRODUCTION: Surgical site infection (SSI) presents a ubiquitous concern to surgical specialties, especially in the presence of prosthetic material. Antibiotic-impregnated beads present a novel and evolving means to combat this condition. This review aims to analyze the quality of evidence and methods of antibiotic bead use, particularly for application within vascular surgery. METHODS: A systematic scoping review was conducted within Embase, MEDLINE, and the Cochrane Registry of Randomized Controlled Trials. Articles were evaluated by 2 independent reviewers. Level of evidence was evaluated using the Oxford Center for Evidence-Based Medicine Criteria and the Cochrane Risk of Bias Tool for Randomized Controlled Trials. RESULTS: The search yielded 6951 papers, with 275 included for final analysis. Publications increased in frequency from 1978 to the present. The most common formulation was polymethyl methacrylate; however publications on biodegradable formulations, including calcium sulfate beads, have been published with increasing frequency. Most publications had positive conclusions (94.2%); however, the data was mainly subjective and may be prone to publication bias. Only 11 randomized controlled trials were identified and all but one was evaluated to be at a high risk of bias. The most common indication was for osteomyelitis (52%), orthopedic prosthetic infections (20%), and trauma (9%). Within vascular surgery, beads have been used primarily for the treatment of graft infection, with freedom from recurrence rates being reported from 41% to 87.5%. CONCLUSIONS: Antibiotic-impregnated beads provide a means to deliver high doses of antibiotic directly to a surgical site, without the risks of parenteral therapy. There has yet to be significant high-level quality data published on their use. There is a large body of evidence that suggests antibiotic beads may be used in SSIs in high-risk patients, prosthetic infections, and other complex surgical infections. Important potential areas of application in vascular surgery include graft infection, prevention of wound infection in high-risk patients, and diabetic foot infection.


Assuntos
Antibacterianos/administração & dosagem , Implante de Prótese Vascular/efeitos adversos , Implante de Prótese Vascular/instrumentação , Prótese Vascular/efeitos adversos , Portadores de Fármacos , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibacterianos/efeitos adversos , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/microbiologia , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/microbiologia , Resultado do Tratamento
3.
Recent Pat Biotechnol ; 14(1): 49-62, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31438836

RESUMO

BACKGROUND: Numerous causes of infection in arthroplasties are related to biofilm formation on implant surfaces. In order to circumvent this problem, new alternatives to prevent bacterial adhesion biosurfactants-based are emerging due to low toxicity, biodegradability and antimicrobial activity of several biosurfactants. We revised all patents relating to biosurfactants of applicability in orthopedic implants. METHODS: This work aims to evaluate the capability of a lipopeptide produced by Bacillus subtilis ATCC 19659 isolates acting as inhibitors of the adhesion of Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 29213 onto titanium and stainless steel surfaces and its antimicrobial activity. RESULTS: The adhesion of the strains to the stainless-steel surface was higher than that of titanium. Preconditioning of titanium and stainless-steel surfaces with 10 mg mL-1 lipopeptide reduced the adhesion of E. coli by up to 93% and the adhesion of S. aureus by up to 99.9%, suggesting the strong potential of lipopeptides in the control of orthopedic infections. The minimal inhibitory concentration and minimum bactericidal concentration were 10 and 240 µg mL-1 for E. coli and S. aureus, respectively. CONCLUSION: The lipopeptide produced by Bacillus subtilis ATCC 19659 presented high biotechnological application in human health against orthopedic implants infections.


Assuntos
Proteínas de Bactérias/farmacologia , Biofilmes/efeitos dos fármacos , Lipopeptídeos/farmacologia , Patentes como Assunto , Aço Inoxidável , Titânio , Bacillus subtilis/química , Aderência Bacteriana/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Humanos , Desenho de Prótese , Infecções Relacionadas à Prótese/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Propriedades de Superfície
4.
J Surg Oncol ; 121(1): 57-66, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31197837

RESUMO

INTRODUCTION: Patients with pre-existing lymphedema who undergo total knee arthroplasty (TKA) for osteoarthritis (OA) are at high risk for periprosthetic joint infection. This complication usually requires removal of the implant. This study aimed to investigate whether surgical treatment of lymphedema reduces the rate of prosthesis removal in such patients. MATERIALS AND METHODS: We retrospectively reviewed our prospective database of patient information collected between January 2009 and December 2018. A total of 348 cases of lower extremity lymphedema were reviewed, and those who underwent total knee TKA for OA of the knee were included. Patient demographics, clinical data, lymphedema surgical history, and TKA surgical history including any episodes of removal were collected and analyzed. RESULTS: There were nine of 15 lymphedema patients with knee OA who subsequently underwent TKA. The mean patient age was 70.4 ± 7.1 years. A total of 18 TKAs were performed in nine patients. The knee prosthesis removal rate was 66.7% (12/18). The prosthesis removal rate was 40% (2/5) in patients who underwent lymphedema microsurgery vs 76.9% (10/13) for those who did not (P = .03). CONCLUSIONS: Pre-existing lymphedema is associated with a high rate of knee prosthesis removal. Lymphedema microsurgery reduced the removal rate of knee prostheses. We recommend that lymphedema microsurgery be considered for patients who require TKA as a treatment for of the knee.


Assuntos
Artroplastia do Joelho/efeitos adversos , Remoção de Dispositivo , Prótese do Joelho , Linfedema/cirurgia , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Idoso , Artroplastia do Joelho/métodos , Feminino , Humanos , Linfedema/fisiopatologia , Microcirurgia/métodos , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Medicine (Baltimore) ; 98(49): e18068, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804314

RESUMO

BACKGROUND: Surgical-site infections after primary total joint arthroplasty (TJA) are a significant issue. Antibiotic-impregnated bone cement (AIBC) has been widely used for the treatment of infected joints, but routine use of AIBC in primary TJA remains controversial. In this systematic review, we evaluated the efficacy of AIBC in reducing surgical-site infections after primary TJA. METHODS: We systematically searched Pubmed, EMbase, Cochrane Library, CMB, CNKI, and WanFang Data for studies (published until June 1, 2019) evaluating AIBC use in reducing infection rates. Two reviewers independently screened the literature according to inclusion and exclusion criteria, extracted data, and assessed the methodological quality of included studies. Meta-analysis was performed using Review Manager 5.3 software. The registration number is CRD42017078341 in PROSPERO. RESULTS: In total, 10 studies were included, resulting in a sample size of 13,909 arthroplasty cases. The overall pooled data demonstrated that, compared with systemic antibiotics, AIBC was more effective in decreasing deep infection rates (odds ratio [OR] = 0.35, 95% confidence interval [CI] = 0.14-0.89, P = .030), although there were higher superficial infection rates with AIBC (OR = 1.53, 95% CI = 1.11-2.11, P = .010). Compared to systemic antibiotics alone, AIBC with systemic antibiotics significantly decreased deep infection rates (OR = 0.55, 95% CI = 0.41-0.75, P = .0001) but there was no difference in superficial infection rates (OR = 1.43, 95% CI = 0.81-2.54, P = .220). In the subgroup analysis, both randomized controlled trials and cohort studies had reduced deep infection rates after primary TJA (OR = 0.61, 95% CI = 0.37-0.99, P = .050 and OR = 0.49, 95% CI = 0.34-0.70, P = .0001, respectively). AIBC decreased deep infection rates in both total hip and knee arthroplasty (OR = 0.25, 95% CI = 0.12-0.52, P = .0002 and OR = 0.62, 95% CI = 0.45-0.87, P = .005, respectively). Deep infection rates were significantly decreased by AIBC with gentamicin (OR = 0.31, 95% CI = 0.20-0.49, P < .00001) but unaffected by AIBC with cefuroxime (OR = 0.35, 95% CI = 0.10-1.20, P = .100). Deep infection rates in the AIBC and control groups were similar when laminar airflow was applied to the operating room (OR = 0.90, 95% CI = 0.60-1.35, P = .620); however, without laminar airflow, the efficacy of AIBC in decreasing deep infection rates was significantly higher than that of control group (OR = 0.21, 95% CI = 0.08-0.59, P = .003). CONCLUSIONS: AIBC may significantly decrease deep infection rates after primary total hip and knee arthroplasty, with or without systemic antibiotics.


Assuntos
Antibacterianos/administração & dosagem , Antibioticoprofilaxia/métodos , Artroplastia de Quadril/métodos , Artroplastia do Joelho/métodos , Cimentos para Ossos/química , Infecções Relacionadas à Prótese/prevenção & controle , Administração Oral , Antibacterianos/uso terapêutico , Humanos , Razão de Chances , Infecção da Ferida Cirúrgica/prevenção & controle
6.
Bone Joint J ; 101-B(11): 1331-1347, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31674244

RESUMO

AIMS: Antibiotic-loaded bone cements (ALBCs) may offer early protection against the formation of bacterial biofilm after joint arthroplasty. Use in hip arthroplasty is widely accepted, but there is a lack of evidence in total knee arthroplasty (TKA). The objective of this study was to evaluate the use of ALBC in a large population of TKA patients. MATERIALS AND METHODS: Data from the National Joint Registry (NJR) of England and Wales were obtained for all primary cemented TKAs between March 2003 and July 2016. Patient, implant, and surgical variables were analyzed. Cox proportional hazards models were used to assess the influence of ALBC on risk of revision. Body mass index (BMI) data were available in a subset of patients. RESULTS: Of 731 214 TKAs, 15 295 (2.1%) were implanted with plain cement and 715 919 (97.9%) with ALBC. There were 13 391 revisions; 2391 were performed for infection. After adjusting for other variables, ALBC had a significantly lower risk of revision for any cause (hazard ratio (HR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; p < 0.001). ALBC was associated with a lower risk of revision for all aseptic causes (HR 0.85, 95% CI 0.77 to 0.95; p < 0.001) and revisions for infection (HR 0.84, 95% CI 0.67 to 1.01; p = 0.06). The results were similar when BMI was added into the model, and in a subanalysis where surgeons using only ALBC over the entire study period were excluded. Prosthesis survival at ten years for TKAs implanted with ALBC was 96.3% (95% CI 96.3 to 96.4) compared with 95.5% (95% CI 95.0 to 95.9) in those implanted with plain cement. On a population level, where 100 000 TKAs are performed annually, this difference represents 870 fewer revisions at ten years in the ALBC group. CONCLUSION: After adjusting for a range of variables, ALBC was associated with a significantly lower risk of revision in this registry-based study of an entire nation of primary cemented knee arthroplasties. Using ALBC does not appear to increase midterm implant failure rates. Cite this article: Bone Joint J 2019;101-B:1331-1347.


Assuntos
Antibacterianos/administração & dosagem , Artroplastia do Joelho/métodos , Cimentos para Ossos , Prótese do Joelho/efeitos adversos , Adulto , Idoso , Anticoagulantes/uso terapêutico , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Tromboembolia/prevenção & controle , Resultado do Tratamento
7.
Sheng Wu Yi Xue Gong Cheng Xue Za Zhi ; 36(5): 862-869, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31631637

RESUMO

Despite the continuous improvement in perioperative use of antibiotics and aseptic techniques, the incidence of infection continues to rise as the need for surgery increasing and brings great challenges to orthopedic surgery. The rough or porous structure of the prosthesis provides an excellent place for bacterial adhesion, proliferation and biofilm formation, which is the main cause of infection. Traditional antibiotic therapy and surgical debridement are difficult to determine whether the infected focus have been removed completely and whether the infection will recur. In recent years, nanotechnology has shown obvious advantages in biomaterials and drug delivery. Nano drug carriers can effectively achieve local antimicrobial therapy, prevent surgical infection by local sustained drug release or intelligent controlled drug release under specific stimuli, and reduce the toxic side effects of drugs. The unique advantages of nanotechnology provide new ideas and options for the prevention and treatment of periprosthetic infection. At present, the application of nano-technology in the prevention and treatment of infection can be divided into the addition of nano-drug-loaded materials to prosthesis materials, the construction of drug-loaded nano-coatings on the surface of prosthesis, the perfusable nano-antimicrobial drug carriers, and the stimulation-responsive drug controlled release system. This article reviews the methods of infection prevention and treatment in orthopaedic surgery, especially the research status of nanotechnology in the prevention and treatment of periprosthetic infection.


Assuntos
Anti-Infecciosos/administração & dosagem , Portadores de Fármacos , Nanotecnologia , Ortopedia , Infecções Relacionadas à Prótese/prevenção & controle , Aderência Bacteriana , Humanos
8.
Ned Tijdschr Tandheelkd ; 126(10): 513-520, 2019 Oct.
Artigo em Holandês | MEDLINE | ID: mdl-31613280

RESUMO

A systematic literature review was carried out in order to formulate a new Dutch guideline regarding policies for patients with a joint prosthesis who are to undergo a dental procedure. The research question was: Is antibiotic prophylaxis indicated in patients with a joint prosthesis who undergo dental procedures? The literature comprised studies in which patients with joint prostheses underwent a dental procedure resulting in hematogenous periprosthetic joint infection or in which a correlation between prophylactic antibiotics and hematogenous periprosthetic joint infection were described. The GRADE/AGREE II method was used to determine the strength of the evidence. A supplementary review of literature to gain further insight into pathophysiology, risk factors and risk intervention was carried out. The included studies did not provide any conclusive evidence that the use of antibiotic prophylaxis reduces the incidence of dental hematogenous periprosthetic joint infection. The results of the supplementary review of literature also supported the conclusion that antibiotic prophylaxis should be discouraged in dental procedures.


Assuntos
Antibioticoprofilaxia , Assistência Odontológica/normas , Infecções Relacionadas à Prótese , Artroplastia de Substituição , Humanos , Prótese Articular , Guias de Prática Clínica como Assunto , Infecções Relacionadas à Prótese/prevenção & controle
9.
APMIS ; 127(12): 779-788, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31515843

RESUMO

Cefuroxime is widely used as antibiotic prophylaxis for orthopaedic procedures. We evaluated bone, subcutaneous tissue (SCT) and plasma pharmacokinetics of cefuroxime in male patients undergoing total knee replacement (TKR) after both traditional short-term infusion (STI) and continuous infusion (CI). Eighteen male patients undergoing TKR were randomly assigned to STI or CI of 1.5 g of cefuroxime. Measurements were obtained in plasma, SCT, cancellous and cortical bone every 30 min for 8 h following surgery. For sampling in solid tissues, microdialysis was applied. Population pharmacokinetic modelling was performed in order to estimate pharmacokinetic parameters, and to assess the probability of attaining cefuroxime concentrations above clinically relevant minimal inhibitory concentrations (MICs) for 65% and 90% of the 8 h dosing interval. Low SCT and cortical bone penetration were found in both the STI and the CI group, but the findings were only significant in the STI group. Irrespective of MIC, tissue and target, CI leads to improved probability of attaining relevant pharmacokinetic targets compared with STI. For the Staphylococcus aureus MIC breakpoint (4 µg/mL), STI leads to inadequate probability of target attainment. CI of 1.5 g of cefuroxime leads to improved probability of attaining relevant pharmacokinetic targets in male TKR patients compared with traditional STI. These findings suggest that application of CI may improve antibiotic prophylaxis for male TKR patients.


Assuntos
Antibacterianos/administração & dosagem , Antibacterianos/farmacocinética , Antibioticoprofilaxia/métodos , Artroplastia do Joelho , Cefuroxima/administração & dosagem , Cefuroxima/farmacocinética , Infecções Relacionadas à Prótese/prevenção & controle , Idoso , Antibacterianos/sangue , Osso e Ossos/metabolismo , Cefuroxima/sangue , Esquema de Medicação , Humanos , Infusões Intravenosas , Masculino , Testes de Sensibilidade Microbiana , Microdiálise , Pessoa de Meia-Idade , Tela Subcutânea/metabolismo
10.
Trans Am Clin Climatol Assoc ; 130: 136-144, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31516177

RESUMO

A global outbreak of invasive Mycobacterium chimaera infections has been associated with exposure to certain heater-cooler devices (HCDs) used during cardiopulmonary bypass. Outbreak investigations have shown that these HCDs harbor M. chimaera in water circuits and generate bio-aerosols in the operating room, leading to airborne transmission to patients during surgery. Whole genome sequencing data support a common-source outbreak originating at an HCD manufacturing facility. Most clinical infections are associated with implanted devices, diagnosis is often delayed, and treatment requires device removal and prolonged antibiotic therapy. Because it is nearly impossible to eradicate M. chimaera from HCDs using existing disinfection approaches, strict separation of HCD exhaust from operating room air is necessary to prevent patient exposure. Lessons learned from this outbreak include: 1) medical device risks are difficult to predict, requiring improved expert review before approval, and 2) advances in genomics provide powerful tools for outbreak investigation and public health surveillance.


Assuntos
Aerossóis , Ponte Cardiopulmonar , Surtos de Doenças , Infecções por Micobactéria não Tuberculosa/epidemiologia , Mycobacterium , Infecções Relacionadas à Prótese/epidemiologia , Equipamentos Cirúrgicos/microbiologia , Infecção da Ferida Cirúrgica/epidemiologia , Microbiologia da Água , Procedimentos Cirúrgicos Cardiovasculares , Humanos , Infecções por Micobactéria não Tuberculosa/microbiologia , Infecções por Micobactéria não Tuberculosa/prevenção & controle , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/microbiologia , Complicações Pós-Operatórias/prevenção & controle , Implantação de Prótese , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Suíça/epidemiologia , Fatores de Tempo , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
11.
J Orthop Res ; 37(12): 2655-2660, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31373384

RESUMO

Several antibacterial materials have been developed to prevent periprosthetic joint infection and thus prevent serious complications for patients and surgeons. However, no study has addressed the activity of antibacterial materials against hematogenous infection. The present study evaluated the antibacterial activity of a silver-containing hydroxyapatite-coated implant against methicillin-resistant Staphylococcus aureus (MRSA) hematogenous infection. Implants coated with hydroxyapatite and silver-hydroxyapatite were inserted into rats' right and left femurs, respectively, after which the animals were infected with S. aureus via a tail vessel. About 107 colony-forming units was the optimal bacterial number for the establishment of S. aureus hematogenous infection. Bacterial loads and C-reactive protein in the blood were measured to confirm bacteremia and inflammation. Fourteen days after the infection, bacterial loads were statistically lower in the femurs containing silver-hydroxyapatite-coated implants than in those with hydroxyapatite-coated implants (p = 0.022). Thus, silver-hydroxyapatite-coated implants might provide antibacterial activity against MRSA hematogenous infection in the postoperative period. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2655-2660, 2019.


Assuntos
Antibacterianos/farmacologia , Durapatita/farmacologia , Fêmur/microbiologia , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/prevenção & controle , Animais , Materiais Revestidos Biocompatíveis , Masculino , Ratos , Ratos Sprague-Dawley , Prata/farmacologia
13.
Bone Joint J ; 101-B(7): 848-851, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31256673

RESUMO

AIMS: The aims of this study were to compare the mean duration of antibiotic release and the mean zone of inhibition between vancomycin-loaded porous tantalum cylinders and antibiotic-loaded bone cement at intervals, and to evaluate potential intrinsic antimicrobial properties of tantalum in an in vitro medium environment against methicillin-sensitive Staphylococcus aureus (MSSA). MATERIALS AND METHODS: Ten porous tantalum cylinders and ten cylinders of cement were used. The tantalum cylinders were impregnated with vancomycin, which was also added during preparation of the cylinders of cement. The cylinders were then placed on agar plates inoculated with MSSA. The diameter of the inhibition zone was measured each day, and the cylinders were transferred to a new inoculated plate. Inhibition zones were measured with a Vernier caliper and using an automated computed evaluation, and the intra- and interobserver reproducibility were measured. The mean inhibition zones between the two groups were compared with Wilcoxon's test. RESULTS: MSSA was inhibited for 12 days by the tantalum cylinders and for nine days by the cement cylinders. At day one, the mean zone of inhibition was 28.6 mm for the tantalum and 19.8 mm for the cement group (p < 0.001). At day ten, the mean zone of inhibition was 3.8 mm for the tantalum and 0 mm for the cement group (p < 0.001). The porous tantalum cylinders soaked only with phosphate buffered solution showed no zone of inhibition. CONCLUSION: Compared with cement, tantalum could release antibiotics for longer. Further studies should assess the advantages of using antibiotic-loaded porous tantalum implants at revision arthroplasty. Cite this article: Bone Joint J 2019;101-B:848-851.


Assuntos
Antibacterianos/administração & dosagem , Cimentos para Ossos , Sistemas de Liberação de Medicamentos , Staphylococcus aureus/efeitos dos fármacos , Tantálio , Vancomicina/administração & dosagem , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Artroplastia de Substituição/instrumentação , Humanos , Prótese Articular , Testes de Sensibilidade Microbiana , Variações Dependentes do Observador , Infecções Relacionadas à Prótese/prevenção & controle , Fatores de Tempo , Vancomicina/farmacologia , Vancomicina/uso terapêutico
14.
J Mater Sci Mater Med ; 30(7): 83, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31273466

RESUMO

Infection and encrustation limit the use of ureteral stent and to data no device can completely solve these complications. The Cu-bearing stainless steel is a novel material with properties of inhibiting infection and decreasing encrustation in vitro. In this work, ureteral stents were fabricated and implanted into the bladder of New Zealand rabbits, aiming to further investigate the effects of material on bacterial survival and growth as well as the implant related encrustation. Less adherent microbes and deposited crystals on Cu-bearing stainless steel stents were found, with significant differences in comparison with stainless steel stents, which further support the development of biofunctional ureteral stents.


Assuntos
Materiais Revestidos Biocompatíveis/química , Cobre/química , Infecções Relacionadas à Prótese/prevenção & controle , Aço Inoxidável/química , Stents , Bexiga Urinária/microbiologia , Animais , Aderência Bacteriana , Infecções Bacterianas/prevenção & controle , Cálcio/química , Feminino , Magnésio/química , Teste de Materiais , Coelhos , Ureter , Bexiga Urinária/cirurgia
15.
J Bone Joint Surg Am ; 101(13): 1144-1150, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31274715

RESUMO

BACKGROUND: Povidone-iodine (PI) irrigation is often used prior to wound closure in total joint arthroplasty, but there are limited reports evaluating its efficacy in decreasing joint infections. The goal of this study was to compare the rate of any reoperation for infection (both superficial and deep) in primary total hip arthroplasty (THA) and primary total knee arthroplasty (TKA) among patients who did and did not receive PI irrigation prior to wound closure. METHODS: Using our institution's total joint registry, we identified 5,534 primary THA and 6,204 primary TKA procedures performed from 2013 to 2017. Cases were grouped on the basis of whether or not the wound was irrigated with 1 L of 0.25% PI prior to closure. PI irrigation was used in 1,322 (24%) of the THA cases and in 2,410 (39%) of the TKA cases. The rates of reoperation for infection at 3 months and 1 year were compared between the 2 groups. The same comparisons were then performed using propensity scores to account for differences in baseline characteristics. RESULTS: The rate of reoperation for infection as assessed at 3 months following THA was similar between those who received dilute PI irrigation (0.9%) and who did not (0.7%) (p = 0.7). At 1 year, the rate of reoperation for infection was similar between those who received dilute PI irrigation (0.7%) and those who did not (0.9%) (p = 0.6). After using the propensity score, there was no difference between the groups in the risk of septic reoperations. For TKA, the rate of reoperation as assessed at 3 months was similar between those who received dilute PI irrigation (0.8%) and those who did not (0.3%) (p = 0.06). At 1 year, there was a greater rate of reoperations for infection among those who received dilute PI irrigation (1.2%) compared with those who did not (0.6%) (p = 0.03). However, there was no difference in the risk of septic reoperations between the groups after using the propensity score. CONCLUSIONS: Despite enthusiasm for and progressive adoption of the use of dilute PI irrigation at our institution, there was not a significant reduction in the risk of reoperation for infection as assessed at 3 months and 1 year following primary THA and TKA. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Povidona-Iodo/administração & dosagem , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Irrigação Terapêutica , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Reoperação/estatística & dados numéricos , Técnicas de Fechamento de Ferimentos
16.
J Bone Joint Surg Am ; 101(13): 1151-1159, 2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31274716

RESUMO

BACKGROUND: Postoperative infection remains a major challenge in revision total hip arthroplasty (THA) and revision total knee arthroplasty (TKA). Wound irrigation with dilute povidone-iodine (PI) solution has emerged as a simple, inexpensive, and potentially successful means of reducing postoperative infections. The aim of this study was to assess its effectiveness in reducing infection following revision THA and TKA in, to our knowledge, the largest revision cohort to date. METHODS: Using our institution's total joint registry, we identified 1,402 revision THAs and 1,482 revision TKAs performed during the study period (2013, when the PI irrigation protocol was first implemented, to 2017). The PI lavage protocol was employed in 27% of the revision THA cases and 34% of the revision TKA cases; in the remaining cases, the protocol was not used. Demographics, comorbid conditions, underlying surgical diagnoses, and whether the revision was for a septic or an aseptic etiology were compared between the groups (use or no use of PI irrigation). Any reoperation due to infection, as assessed at 3 and 12 months following revision arthroplasty, was compared between the groups and propensity scores were calculated to account for differences in baseline characteristics between the groups. RESULTS: After adjusting for baseline differences between the groups using the propensity-score weighted models, we found no significant difference in the rate of reoperation for infection at 3 months (p = 0.58 for revision THA, and p = 0.06 for revision TKA) and at 12 months (p = 0.78 for revision THA, and p = 0.06 for revision TKA). Nonetheless, the hazard ratios from the propensity-score model trended higher for patients who received PI lavage: 1.6 and 1.3 for revision THA at 3 and 12 months, respectively, and 2.9 at both 3 and 12 months for revision TKA. CONCLUSIONS: PI wound lavage demonstrated no benefit in reducing any reoperation for infection following revision THA and TKA. Moreover, the trend toward higher rates for reoperation for infection among patients who received PI irrigation merit further consideration. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Artroplastia de Quadril , Artroplastia do Joelho , Povidona-Iodo/administração & dosagem , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Irrigação Terapêutica , Idoso , Feminino , Humanos , Masculino , Sistema de Registros , Reoperação
18.
Foot Ankle Int ; 40(1_suppl): 12S-14S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322928

RESUMO

RECOMMENDATION: Though one study supporting topically applied vancomycin has shown it to reduce the rate of deep infection in diabetic patients undergoing foot and ankle surgery, there is insufficient evidence to show benefits or to show any risks associated with the use of vancomycin powder during total ankle arthroplasty (TAA) or other foot and ankle procedures in a general population. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Antibacterianos/administração & dosagem , Pós/administração & dosagem , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/administração & dosagem , Administração Tópica , Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo , Consenso , Pé/cirurgia , Humanos , Cuidados Intraoperatórios , Infecções Relacionadas à Prótese/microbiologia , Infecção da Ferida Cirúrgica/microbiologia
19.
Foot Ankle Int ; 40(1_suppl): 4S-6S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322934

RESUMO

RECOMMENDATION: Unknown. The role of screening for methicillin-resistant Staphylococcus aureus (MRSA) and decolonization prior to total ankle arthroplasty (TAA) remains unclear. Further data are needed to support this practice in TAA, which can be costly and logistically difficult to implement. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Artroplastia de Substituição do Tornozelo , Programas de Rastreamento , Staphylococcus aureus Resistente à Meticilina , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Consenso , Humanos
20.
Foot Ankle Int ; 40(1_suppl): 6S-8S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322935

RESUMO

RECOMMENDATION: We recommend that patients awaiting total ankle arthroplasty (TAA) be optimized prior to surgery by implementing skin cleansing, nutritional status enhancement, glycemic control, body mass index (BMI) optimization, smoking cessation, and management of immune-modulating comorbidities. At the time of surgery, there is strong evidence that optimal preparation of the surgical site with an alcohol-containing agent, weight-based and timely administration of antibiotic prophylaxis, and reducing operating room traffic should also be put in place. LEVEL OF EVIDENCE: Moderate. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Artroplastia de Substituição do Tornozelo , Infecções Relacionadas à Prótese/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Antibioticoprofilaxia , Índice de Massa Corporal , Comorbidade , Consenso , Humanos , Apoio Nutricional , Fatores de Risco , Higiene da Pele , Abandono do Hábito de Fumar
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