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1.
New Microbiol ; 43(3): 107-114, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32596741

RESUMO

Prosthetic joint infections (PJI) represent the most serious cause of prosthetic joint loosening, with high impact on patient life and health economics. Although not entirely reliable, the cultivation of intraoperative prosthetic tissue or synovial fluid remains the gold standard for determining the cause of PJI. Therefore, molecular methods are increasingly being introduced. The aim of this study was to optimize and assess an alternative molecular approach with the use of bacteriophage K for more rapid and specific detection of staphylococci in sonicate fluid (SF) of PJI. The best results with the method were obtained after 180 min of sample incubation with 104 PFU/mL of bacteriophage K. DNA isolation prior to qPCR analysis was confirmed unnecessary, while chloroform addition to samples after incubation with bacteriophage K improved bacterial detection by 100×. The method had a limit of detection of 6.8×102 CFU/mL and was found suitable for the detection of staphylococci in SF of removed prosthetic joints, giving results comparable to standard microbiological methods in just four hours. The optimized method was found fit for the purpose, offering potential advantages over the use of molecular detection methods to detect bacterial DNA.


Assuntos
Prótese Articular , Infecções Relacionadas à Prótese , Bactérias , Bacteriófagos/genética , Humanos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Sensibilidade e Especificidade , Líquido Sinovial
2.
Medicine (Baltimore) ; 99(15): e19735, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282732

RESUMO

INTRODUCTION: The increase in the number of patients with prosthetic joints will entail a rise in the absolute number of infections associated with these procedures. Although less frequent, infections by Candida species are also expected to increase, and the clinical and surgical management of these cases is based on case reports and opinion of specialists. The objective of the present study was to review the available literature and describe the cases of prosthetic joint infection caused by Candida species in patients of the Institute of Orthopedics and Trauma of the University of São Paulo Faculty of Medicine Clinics Hospital (IOT-HCFMUSP) between 2007 and 2014. PATIENT CONCERNS: Eleven patients were diagnosed with prosthetic joint infection due to Candida with mean age of 65 years. The most frequent comorbidities were heart disease and diabetes mellitus, and the main personal antecedent was previous bacterial infection in the prosthetic joint. At least one risk factor for fungal infection was present in 73% of the patients. There was no difference between the prevalence of infections caused by Candida albicans and non-albicans Candida species, and there was bacterial co-infection in 55% of the cases. DIAGNOSIS: For building up the case series, patients with cultures of bone and joint specimens that were positive for Candida species and had a clinical diagnosis of prosthetic joint infection were included in the case series. INTERVENTIONS: Surgical debridement with removal of the prosthesis was the most frequently used surgical approach (45%). All patients were treated with monotherapy, and the most frequently used antifungal agent was fluconazole. The total duration of antifungal therapy was 6 months in 73% of the cases. OUTCOMES: After the initial management, 73% of the patients achieved clinical remission. CONCLUSION: The most indicated initial management was debridement with removal of the prosthesis, and the most used treatment regimen was fluconazole monotherapy. The most prevalent treatment duration was 6 months. The initial management led to a favorable outcome in 73% of the cases. DESCRIPTORS: Prosthetic joint infection, Candida, treatment, and diagnosis.


Assuntos
Candida albicans/isolamento & purificação , Prótese Articular/microbiologia , Osteoartrite/cirurgia , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , Idoso , Idoso de 80 Anos ou mais , Antifúngicos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/cirurgia , Coinfecção/epidemiologia , Comorbidade , Desbridamento/métodos , Feminino , Fluconazol/uso terapêutico , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Micoses/tratamento farmacológico , Micoses/epidemiologia , Micoses/cirurgia , Osteoartrite/complicações , Prevalência , Infecções Relacionadas à Prótese/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Acta Orthop ; 91(4): 444-449, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32285738

RESUMO

Background and purpose - Total ankle arthroplasties (TAAs) have larger revision rates than hip and knee implants. We examined the survival rates of our primary TAAs, and what different factors, including the cause of arthritis, affect the success and/or revision rate.Patients and methods - From 2004 to 2016, 322 primary Hintegra TAAs were implanted: the 2nd generation implant from 2004 until mid-2007 and the 3rd generation from late 2007 to 2016. A Cox proportional hazards model evaluated sex, age, primary diagnosis, and implant generation, pre- and postoperative angles and implant position as risk factors for revision.Results - 60 implants (19%) were revised, the majority (n = 34) due to loosening. The 5-year survival rate (95% CI) was 75% (69-82) and the 10-year survival rate was 68% (60-77). There was a reduced risk of revision, per degree of increased postoperative medial distal tibial angle at 0.84 (0.72-0.98) and preoperative talus angle at 0.95 (0.90-1.00), indicating that varus ankles may have a larger revision rate. Generation of implant, sex, primary diagnosis, and most pre- and postoperative radiological angles did not statistically affect revision risk.Interpretation - Our revision rates are slightly above registry rates and well above those of the developer. Most were revised due to loosening; no difference was demonstrated with the 2 generations of implant used. Learning curve and a low threshold for revision could explain the high revision rate.


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Prótese Articular , Falha de Prótese/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Articulação do Tornozelo/diagnóstico por imagem , Articulação do Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo/estatística & dados numéricos , Feminino , Humanos , Prótese Articular/efeitos adversos , Prótese Articular/estatística & dados numéricos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Modelos de Riscos Proporcionais , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
4.
Orthop Clin North Am ; 51(2): 141-146, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138852

RESUMO

Prosthetic joint infection is still a rare but devastating complication following total hip and knee arthroplasty. The incidence of prosthetic joint infection ranges from 2% to 4% in primary procedures as opposed to nearly 20% in revisions. The challenges that arise here include mainly diagnostic uncertainty, management in immunocompromised patients, recurrent infection, infection around a well-fixed implant, and substantial bone loss, and require careful preoperative assessment and well-defined management plans. This article summarizes recent developments in the diagnosis and management of this increasingly prevalent issue specifically focusing on outcomes following debridement, antibiotics, and implants retention and one-stage revision procedures.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia do Joelho/efeitos adversos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Antibacterianos/uso terapêutico , Biomarcadores/análise , Desbridamento , Remoção de Dispositivo , Humanos , Prótese Articular/efeitos adversos , Prótese Articular/microbiologia , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/microbiologia , Reino Unido
5.
Orthop Clin North Am ; 51(2): 293-302, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138866

RESUMO

Brazil experiences a late participation in total ankle arthroplasty, which could have positive and negative aspects. The positive view argues about the modern implants that Brazil has received in the past years, skipping the early total ankle replacement generation who present more complications and low survival rate in the literature. The negative aspects are related to gap of experience with Brazilian surgeons unable to participate in the development of the technique and implant designs during these years. This article discusses the aspects of the Brazilian experience with total ankle replacement since the earliest procedures performed.


Assuntos
Articulação do Tornozelo/cirurgia , Artrite/cirurgia , Artroplastia de Substituição do Tornozelo , Prótese Articular , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Artrite/diagnóstico por imagem , Artroplastia de Substituição do Tornozelo/efeitos adversos , Brasil , Feminino , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
6.
Plast Reconstr Surg ; 145(3): 746-754, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097319

RESUMO

Research bias, or the systematic errors of a study, can arise before, during, or after a trial ends. These biases hinder the internal validity of the study, which is the accuracy of a study's conclusions regarding the effects of an intervention on a given group of subjects. With the growing use of evidence-based medicine, there is a demand for high-quality evidence from the research community. Systematic reviews and meta-analyses of randomized controlled trials are considered the highest level of evidence, followed by individual randomized controlled trials. However, most surgical trials cannot be conducted as randomized controlled trials because of factors such as patient preferences and lack of equipoise among surgeons. Therefore, surgical trials may lack features that are held as important standards for high-quality evidence, such as randomization and blinding. To demonstrate the biases that surgical trials may encounter, the authors examined a prospective cohort study, the Silicone Arthroplasty in Rheumatoid Arthritis study. The authors focus on the challenges that arise during a surgical trial, including the design, implementation, and methods used to report the clinical evidence. By recognizing and addressing obstacles that exist in research, investigators will provide health care providers with high-quality evidence needed to make well-informed, evidence-based clinical decisions.


Assuntos
Artrite Reumatoide/cirurgia , Artroplastia/efeitos adversos , Prótese Articular/efeitos adversos , Avaliação de Resultados em Cuidados de Saúde/normas , Projetos de Pesquisa/normas , Artrite Reumatoide/epidemiologia , Artroplastia/instrumentação , Artroplastia/normas , Viés , Tomada de Decisão Clínica , Ensaios Clínicos como Assunto/normas , Medicina Baseada em Evidências/normas , Seguimentos , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Seleção de Pacientes , Estudos Prospectivos , Silicones/efeitos adversos
7.
Eur J Orthop Surg Traumatol ; 30(2): 313-321, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31578679

RESUMO

INTRODUCTION: Prosthetic joint infection (PJI) remains one of the major challenges facing orthopaedic surgeons. There is a paucity of evidence on non-operative management of PJI. We present the results of prolonged antibiotic suppression therapy (PSAT) in PJI from a single centre. METHODS: A retrospective study was performed. Twenty-six patients were included. Two patients were excluded due to the lack of follow-up data. Failure was defined as admission for sepsis from the joint or amputation. RESULTS: Average age was 72 years (range 35-93). Mean Charlson co-morbidity index was 4.3. Mean follow-up was 3.2 years (range 1.3-5.7). Staphylococcal species were isolated in 11 cases (44%) (MRSA 1, MSSA 5, Staph. epidermidis 4 and Staph Pasteuri 1). Other bacteria included E. Coli (2), Streptococci spp. (3), Propionebacterium acnes (1) and Pseudomonas aeruginosa (1). Four cases were polymicrobial infection (16%), and no organisms were identified in two cases (8%). Candida albicans was identified in one case. All cases of bacterial infection were treated with prolonged oral doxycycline or amoxicillin. Twenty patients (80%) received 6 weeks of intravenous antibiotics prior to commencing prolonged oral antibiotics. Two patients experienced persistent symptoms and required amputation (both TKA). Two patients experienced sepsis but were treated successfully with IV antibiotics alone. The success rate of PSAT was 84% (21/25) successful at an average 3.2-year follow-up. DISCUSSION AND CONCLUSION: Prolonged suppressive antibiotic therapy is a viable option for the management of PJI with a low incidence of complications.


Assuntos
Antibacterianos/uso terapêutico , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Administração Intravenosa , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/administração & dosagem , Humanos , Prótese Articular/microbiologia , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/microbiologia , Estudos Retrospectivos , Sepse/prevenção & controle
9.
J Bone Joint Surg Am ; 102(4): 283-291, 2020 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-31855870

RESUMO

BACKGROUND: Periprosthetic joint infection (PJI) is a severe complication with increasing incidence. However, we are not aware of any robust data on patients having PJI at the same time in ≥2 joints that had undergone total joint arthroplasty, referred to as synchronous PJI throughout this article. The aims of this study were to investigate the probability of the development of synchronous PJI of another prosthetic joint and to identify possible clinical risk factors for the development of synchronous PJI. In addition, we aimed to determine whether routine aspiration of all other prosthetic joints was warranted after a diagnosis of PJI in a single joint. METHODS: A total of 2,532 septic revision procedures were performed during the study period. In the final analysis, 644 patients (26 with synchronous PJI and 618 with non-synchronous PJI) with 1,508 prosthetic joints were included. The mean age (and standard deviation) was 71 ± 9.6 years. Using bivariate analyses, we calculated the odds of synchronous PJI as a function of various demographic and clinical variables. RESULTS: A suspicious clinical presentation of the non-primary joint had the strongest association with synchronous PJI (odds ratio [OR], 58.5 [95% confidence interval (CI), 22.4 to 152.8]). Additional associations with synchronous PJI were detected for a history of neoplasia (OR, 12 [95% CI, 3.9 to 37.2]), the use of immune-modulating therapy (OR, 9.5 [95% CI, 3.4 to 26.2]), the presence of systemic inflammatory response syndrome or sepsis (OR, 8.4 [95% CI, 2.8 to 25]), and having ≥3 prosthetic joints (OR, 3.0 [95% CI, 1.37 to 6.64]). CONCLUSIONS: Synchronous PJI is a rare but very serious complication and every prosthetic joint should be investigated meticulously. Suspicious clinical presentation, a history of neoplasia, sepsis, immune-modulating therapy, and ≥3 prosthetic joints were identified as risk factors and should increase the physician's vigilance. In the case of PJI, aspiration of each joint that had undergone total joint arthroplasty should be considered. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Prótese Articular , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/prevenção & controle , Sucção , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos
10.
Expert Rev Med Devices ; 17(1): 41-56, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31810395

RESUMO

Introduction: Total joint replacement is one of the most common, safe, and efficacious operations in all of surgery. However, one major long-standing and unresolved issue is the adverse biological reaction to byproducts of wear from the bearing surfaces and modular articulations. These inflammatory reactions are mediated by the innate and adaptive immune systems.Areas covered: We review the etiology and pathophysiology of implant debris-associated inflammation, the clinical presentation and detailed work-up of these cases, and the principles and outcomes of non-operative and operative management. Furthermore, we suggest future strategies for prevention and novel treatments of implant-related adverse biological reactions.Expert opinion: The generation of byproducts from joint replacements is inevitable, due to repetitive loading of the implants. A clear understanding of the relevant biological principles, clinical presentations, investigative measures and treatments for implant-associated inflammatory reactions and periprosthetic osteolysis will help identify and treat patients with this issue earlier and more effectively. Although progressive implant-associated osteolysis is currently a condition that is treated surgically, with further research, it is hoped that non-operative biological interventions could prolong the lifetime of joint replacements that are otherwise functional and still salvageable.


Assuntos
Inflamação/diagnóstico , Inflamação/etiologia , Prótese Articular/efeitos adversos , Falha de Prótese , Quimiocinas/metabolismo , Diagnóstico Diferencial , Humanos , Inflamação/diagnóstico por imagem , Inflamação/fisiopatologia , Resultado do Tratamento
11.
Eur J Orthop Surg Traumatol ; 30(2): 373-381, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31563987

RESUMO

INTRODUCTION: Total ankle arthroplasty (TAA) has the objective to maintain the range of motion of the tibiotarsal joint and to preserve the nearby joints. However, the complication rate and failures remain quite high after TAA. The main objective of the study was to evaluate the improvement in the functional scores of the tibiotarsal arthrodesis after TAA failure. The secondary objective was to assess the specific complications. MATERIALS AND METHODS: This monocentric retrospective series includes 12 patients (nine men, three women, average age 52.5 years) operated between 2003 and 2018. An iliac graft was used in all cases. The arthrodesis was stabilized either by screws or by retrograde nailing. RESULTS: The reoperation was due to painful malleolar conflicts or loosening. The AOFAS score increased from 38/100 to 67/100 (51-86) post-operatively. The fusion was acquired at 3.7 months (3-6) except in two cases. DISCUSSION AND CONCLUSION: The 83% primary fusion rate is in the low average of the literature and 92% fusion rate in the high average after reoperation. All patients were improved even in two non-unions. The results of this study confirm that the arthrodesis after TAA failure is a reliable alternative to the TAA replacement. However, they are lower than those after a first-line arthrodesis.


Assuntos
Articulação do Tornozelo/fisiopatologia , Articulação do Tornozelo/cirurgia , Artrodese , Artroplastia de Substituição do Tornozelo/efeitos adversos , Adulto , Idoso , Articulação do Tornozelo/diagnóstico por imagem , Artrite/etiologia , Artrite/cirurgia , Artrodese/efeitos adversos , Feminino , Humanos , Prótese Articular/efeitos adversos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Falha de Prótese , Reoperação , Estudos Retrospectivos , Ossos do Tarso/cirurgia , Tíbia/cirurgia , Falha de Tratamento
12.
J Orthop Res ; 38(2): 405-416, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31498470

RESUMO

Macrophage-mediated inflammatory reaction to implant wear particles drives bone loss around total joint replacements (TJR). Although most TJR recipients are elderly, studies linking wear particle-activated macrophages and peri-implant osteolysis have not taken into account the multiple effects that aging has on the innate immune system and, in particular, on macrophages. To address this, we compared the wear particle responses of bone marrow macrophages obtained from young (2-month) and aged (18-month) mice. Macrophages were polarized to M0, M1, or M2 phenotypes in vitro, challenged with titanium particles, and their inflammatory response was characterized at multiple time points by quantitative reverse-transcription polymerase chain reaction and enzyme-linked immunosorbent assay. In addition, age-dependent changes in activation of transcription factor nuclear factor-κB were analyzed by a lentiviral vector-based luciferase reporter system. The particle stimulation experiment was further repeated using human primary macrophages isolated from blood donors of different ages. We found that the pro-inflammatory responses were generally higher in macrophages obtained from young mice, but differences between the age groups remained small and of uncertain biological significance. Noteworthily, M2 polarization effectively suppressed the particle-induced inflammation in both young and aged macrophages. These results suggest that aging of the innate immune system per se plays no significant role in the response of macrophages to titanium particles, whereas induction of M2 polarization appears a promising strategy to limit macrophage-mediated inflammation regardless of age. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:405-416, 2020.


Assuntos
Envelhecimento/imunologia , Macrófagos/efeitos dos fármacos , Titânio/toxicidade , Envelhecimento/metabolismo , Animais , Citocinas/metabolismo , Humanos , Prótese Articular/efeitos adversos , Macrófagos/metabolismo , Masculino , Camundongos Endogâmicos C57BL , NF-kappa B/metabolismo , Óxido Nítrico Sintase Tipo II/metabolismo
13.
Acta Orthop Belg ; 85(3): 325-329, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31677628

RESUMO

The purpose of this retrospective study was to describe our experience with failed TMC joint prostheses and to report the results of 7 cases that were treated by a salvage revision arthroplasty. We only performed this salvage arthroplasty when partial (cup replacement) or total replacement of TMC prosthesis was not possible. We performed a resection arthroplasty with (partial) trapezial excision and spacer insertion to prevent scaphometacarpal collaps. We used the proximal part of the Ascencion® MCP implant (Integra) as spacer. Among our 7 patients, 3 were satisfied with a VAS satisfaction of 8 or more. Four patients had pain levels less than or equal to 3. Our mean DASH score was 32.7. Our patients had good opposition and retropulsion scores and the mean TMC joint flexion and abduction values were both 40°. But tip and key pinch ipsilateral was insufficient (mean tip pinch of 2kg and key pinch of 1kg). We believe that the salvage revision arthroplasty with (partial) trapezial excision and spacer insertion is a valuable treatment option for failed TMC joint replacement. But further research needs to compare all the different revision options after TMC joint replacement in a multicenter randomized controlled trial.


Assuntos
Articulações Carpometacarpais/cirurgia , Prótese Articular/efeitos adversos , Reoperação/métodos , Terapia de Salvação/métodos , Polegar/cirurgia , Idoso , Artroplastia de Substituição/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese/efeitos adversos , Estudos Retrospectivos
14.
Medicine (Baltimore) ; 98(45): e17914, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702670

RESUMO

There are very few reports of eczema and other prosthetic-related allergic skin complications following arthroplasty. We aimed to assess the risk of eczema after joint replacement.We performed a retrospective population-based cohort study in 2024 joint replacement patients using the Longitudinal Health Insurance Database. For comparison, 8096 controls were selected, with 4 control subjects for each joint replacement patient matched for age, sex, and index year, to assess eczema risk. We examined 14-year cumulative eczema incidence associated with age, sex, immunity, disease history, and joint replacement location.Eczema rates in the joint replacement patients were 38% higher than in the control group (57.90 vs 41.84 per 1000 person-years, respectively). Compared with the control group, joint replacement patients showed a 1.35-fold increased risk of eczema according to the multivariable Cox model (95% Confidence interval [CI] = 1.23-1.49). Knee replacement patients had higher eczema risk compared with the control group (Hazard ratio [HR] = 1.45, 95% CI = 1.33-1.70). Stratified by study period, the joint replacement cohort had a higher eczema risk after the 3-month follow-up.Our study revealed that joint arthroplasty increased risk of eczema in this 14-year follow-up study, and this was not related to personal atopic history or gender.


Assuntos
Artroplastia de Substituição/efeitos adversos , Eczema/epidemiologia , Prótese Articular/efeitos adversos , Idoso , Artroplastia de Substituição/estatística & dados numéricos , Estudos de Casos e Controles , Comorbidade , Dermatite Alérgica de Contato/epidemiologia , Eczema/etiologia , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Metais/efeitos adversos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco
15.
BMC Musculoskelet Disord ; 20(1): 467, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640638

RESUMO

BACKGROUND: Prosthetic joint infection (PJI) is a challenging complication of total elbow replacement (TER). Potential surgical treatments include one- or two-stage revision; however, the best treatment for elbow PJI is not clearly defined. We conducted a systematic review in accordance with PRISMA guidelines to compare the clinical effectiveness of one- and two-stage revision surgery for elbow PJI using re-infection (recurrent and new infections) rates; mortality; clinical measures of function, pain, and satisfaction; and non-infection related adverse events. METHODS: MEDLINE, Embase, Web of Science, and The Cochrane Library were searched up to June 2019 to identify observational cohort studies and randomised controlled trials (RCTs) that had recruited patients with elbow PJI following TER and treated with one- or two-stage revision. Of 96 retrieved articles, 2 one-stage and 6 two-stage revision studies were eligible. No RCT was identified. Arcsine transformation was used in estimating rates with 95% confidence intervals (CIs). RESULTS: Staphylococcus aureus was the most common causative organism for PJI of the elbow (24 of 71 elbow PJIs). The re-infection rate (95% CI) for one-stage (7 elbows) ranged from 0.0% (0.0-79.3) to 16.7% (3.0-56.4) and that for two-stage revision (87 elbows) from 0.0% (0.0-49.0) to 20.0% (3.6-62.4). Non-infection related adverse event rate for one-stage (based on a single study) was 16.7% (3.0-56.4) and that for two-stage ranged from 11.8% (4.7-26.6) to 20.0% (3.6-62.4). There were no mortality events recorded following one- or two-stage revision surgery and postoperative clinical measures of function, pain, and satisfaction could not be effectively compared because of limited data. CONCLUSIONS: No strong conclusions can be drawn because of limited data. The one-stage revision may be potentially at least as clinically effective as two-stage revision, but further data is needed. There are clear gaps in the existing literature and studies are urgently warranted to assess the clinical effectiveness of one- and two-stage revision strategies for PJI following TER. SYSTEMATIC REVIEW REGISTRATION: PROSPERO 2018: CRD42018118002 .


Assuntos
Artroplastia de Substituição do Cotovelo/efeitos adversos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Reoperação/métodos , Humanos , Recidiva
16.
J Bone Joint Surg Am ; 101(20): 1806-1811, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31626004

RESUMO

BACKGROUND: Infections complicate a minority of orthopaedic arthroplasties but are the leading cause of malpractice claims. The basis for the claims is unclear. The objective of this study was to identify the main deviations from current recommendations by reviewing patient files recorded by a major French medical liability-specialized insurance company for private practitioners (MACSF [Mutuelle d'Assurance du Corps de Santé Français]) and to analyze legal claims and outcomes of litigation. METHODS: All claims data for periprosthetic joint infections were analyzed retrospectively from 2010 to 2014. Treatment strategies were compared with therapeutic guidelines published by medical societies. RESULTS: Forty-five claims for periprosthetic joint infection were recorded; 82% of patients were men and the mean patient age was 63 years. Twenty-one patients (47%) had a knee arthroplasty, 21 had a hip arthroplasty, 2 had a shoulder arthroplasty, and 1 had an ankle arthroplasty. Twenty-three infections (51%) occurred within 1 month postoperatively. Staphylococcus aureus was isolated from intraoperative samples in 36% of the cases (including 25% of these with methicillin-resistant strains), and coagulase-negative staphylococci were isolated in 51% (44% methicillin-resistant strains) of the cases. Treatment lasted for a median of 9.5 months (range, 1.5 to 96 months), with a median of 6 months (range, 1.5 to 20 months) of antibiotics and 3 surgical procedures (range, 0 to 7 surgical procedures). A total of 18% of patients had antibiotic-related side effects, 2% of patients died, and 76% of patients had persistent sequelae. An infectious disease specialist's advice was required for 56% of the patients. Discordances with therapeutic guidelines were found in 76% of the patient files, including delay in diagnosis (44%) and inadequate medical treatment (18%) or medico-surgical treatment (13%). CONCLUSIONS: Late diagnosis of early postoperative infections appears to be the major cause of inappropriate management and malpractice litigation. Discordance with current guidelines was identified. Early consultation with an infectious disease specialist may help to reduce malpractice claims. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia de Substituição/legislação & jurisprudência , Prótese Articular/efeitos adversos , Imperícia/legislação & jurisprudência , Cirurgiões Ortopédicos/legislação & jurisprudência , Infecções Relacionadas à Prótese/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/efeitos adversos , Antibioticoprofilaxia/estatística & dados numéricos , Artroplastia de Substituição/instrumentação , Feminino , França/epidemiologia , Fidelidade a Diretrizes , Humanos , Jurisprudência , Masculino , Pessoa de Meia-Idade , Cirurgiões Ortopédicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Infecções Relacionadas à Prótese/prevenção & controle , Reoperação/estatística & dados numéricos , Estudos Retrospectivos
17.
Acta Ortop Mex ; 33(2): 73-80, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31480107

RESUMO

INTRODUCTION: The objective of this study is to assess the type, frequency and severity of complications after the implantation of the modular monopolar radial head prosthesis. MATERIAL AND METHODS: Forty-seven patients with 48 radial head prostheses implanted between 2009 and 2017 were reviewed retrospectively. Patients were evaluated clinical and radiographically for a mean follow-up of 43.55 months (range: 12-89). RESULTS: The same type of prosthesis was implanted in every patient (Ascension Modular Radial Head). The average score in the Mayo Elbow Performance Score was 88.29 ± 9.9 points. During the follow-up, three patients (6.25%) suffered from continuous pain. Twelve cases (25.5%) showed radiological oversizing, though only five were symptomatic. Heterotopic ossification was detected in twenty-seven cases (57.4%). Eleven patients (23.4%) developed postoperative stiffness. Nineteen cases (40.42%) showed periprosthetic osteolysis, from which seven were symptomatic. Thirteen patients (27%) developed surgery-related complications: three cases of infection, four cases of symptomatic loosening, two neurapraxies, one instability and three cases of oversizing with associated stiffness. Nine patients (18.75%) required reintervention. DISCUSSION: Our study obtains a 27% of overall complications, mostly related to oversizing and prosthetic loosening, and 19% of reinterventions. These results are similar to those presented in previous studies, with variations depending on the time of follow-up. Further research is also required to evaluate long-term results and the potential progression of the radiographic findings. CONCLUSION: Taken together, these data stress the need for improvement in both the surgical technique and the design of the implants.


Assuntos
Articulação do Cotovelo , Prótese Articular , Fraturas do Rádio , Rádio (Anatomia) , Humanos , Prótese Articular/efeitos adversos , Desenho de Prótese , Rádio (Anatomia)/patologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
18.
J Foot Ankle Surg ; 58(5): 1010-1013, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474391

RESUMO

Total ankle arthroplasty is a useful surgical procedure for osteoarthritis of the ankle, but aseptic loosening of components is an issue. We report here a case of aseptic implant loosening with metallosis after total ankle arthroplasty using the TNK ankle (Kyocera, Kyoto, Japan), which occurred despite the components being ceramic. We also report favorable results from our method of treatment using a total talar prosthesis in the revision surgery. During the revision surgery, synovial metallosis was found, probably related to superficial damage to the screw affixing the tibial component to the bone. Because both the tibial and talar components were loose, all the components and the remaining talar bone were removed. A new tibial component and a custom-made alumina-ceramic total talar prosthesis was inserted. Pain relief was achieved and maintained through the latest follow-up visit at 42 months after revision surgery. Dorsiflexion of the ankle improved from 0° to 5° and plantarflexion remained unchanged from its preoperative range of 20°. The American Orthopaedic Foot & Ankle Society ankle-hindfoot score improved from 38 to 80 points. To the best of our knowledge, this is the first reported case of an alumina-ceramic total ankle prosthesis loosening caused by metallosis resulting from screw abrasion. Favorable treatment results were obtained by using a total talar prosthesis in the revision surgery.


Assuntos
Artrodese/instrumentação , Artroplastia de Substituição do Tornozelo/instrumentação , Prótese Articular/efeitos adversos , Osteoartrite/cirurgia , Desenho de Prótese , Idoso de 80 Anos ou mais , Artroplastia de Substituição do Tornozelo/efeitos adversos , Cerâmica , Feminino , Humanos , Falha de Prótese , Reoperação
19.
Foot Ankle Int ; 40(1_suppl): 52S-53S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322930

RESUMO

RECOMMENDATION: Debridement, antibiotics, and implant retention (DAIR) with polyethylene exchange may be indicated in early postoperative infection (<4 weeks) or acute hematogenous infection (<4 weeks of symptoms) in patients with infected total ankle arthroplasty (TAA), although recurrent infection has been seen. Suffcient clinical evidence is lacking. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Artroplastia de Substituição do Tornozelo/efeitos adversos , Desbridamento , Prótese Articular/efeitos adversos , Seleção de Pacientes , Infecções Relacionadas à Prótese/terapia , Irrigação Terapêutica , Artroplastia de Substituição do Tornozelo/instrumentação , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia
20.
Foot Ankle Int ; 40(1_suppl): 48S-52S, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31322933

RESUMO

RECOMMENDATION: We recommend tailoring the antibiotic in cement spacers to the infecting organism if it has been identified, as is typically done in total knee and hip arthroplasty. Otherwise, broad-spectrum antibiotics may be utilized. Medical comorbidities should always be considered, especially with regard to renal function and allergy profile. A thermostable antibiotic should be added to cement. LEVEL OF EVIDENCE: Consensus. DELEGATE VOTE: Agree: 100%, Disagree: 0%, Abstain: 0% (Unanimous, Strongest Consensus).


Assuntos
Antibacterianos/uso terapêutico , Artroplastia de Substituição do Tornozelo/efeitos adversos , Prótese Articular/efeitos adversos , Infecções Relacionadas à Prótese/tratamento farmacológico , Artroplastia de Substituição do Tornozelo/instrumentação , Cimentos para Ossos , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/etiologia
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