1,720,980 research outputs found
Role for irrigation and debridement in periprosthetic infections
No full textIrrigation and debridement (I&D) has been described as a possible option to eradicate early postoperative periprosthetic hip and knee infections, as well as late, acute, and hematogenous ones. Still, the literature fails to uniquely assess the effectiveness of this procedure and often provides conflicting evidence. To reconcile this difference, a systematic review of the available literature from 1970 to 2013 was undertaken. Fifteen articles, for a total of 796 patients, met the inclusion criteria; the average success rate was 44.9 and 52% after a single or repeated I&D procedures, respectively, at an average of 4 years follow-up. Despite the methodological differences and the heterogeneity of the material reviewed, this study demonstrates that this procedure only attains a relatively low success rate of infection eradication, depending on when patients are selected for surgical intervention according to the timeframe of their symptoms
Two-stage revision of septic knee prosthesis with articulating knee spacers yields better infection eradication rate than one-stage or two-stage revision with static spacers
No full textThe best method for treating chronic periprosthetic knee infection
remains controversial. Randomized, comparative studies on treatment modalities are lacking. This systematic review of the literature compares the infection eradication rate after two-stage versus one-stage revision and static versus articulating spacers in two-stage procedures.
METHODS: We reviewed full-text papers and those with an abstract in English published from 1966 through 2011
that reported the success rate of infection eradication after one-stage or
two-stage revision with two different types of spacers.
RESULTS: In all, 6 original articles reporting the results after one-stage knee exchange arthoplasty (n = 204) and 38 papers reporting on two-stage revision (n = 1,421) were reviewed. The average success rate in the eradication of infection was 89.8% after a two-stage revision and 81.9% after a one-stage procedure at a mean follow-up of 44.7 and 40.7 months, respectively. The average infection eradication rate after a two-stage procedure was slightly, although significantly, higher when an articulating spacer rather than a static spacer was
used (91.2 versus 87%).
CONCLUSIONS: The methodological limitations of this study
and the heterogeneous material in the studies reviewed notwithstanding, this
systematic review shows that, on average, a two-stage procedure is associated with a higher rate of eradication of infection than one-stage revision for septic knee prosthesis and that articulating spacers are associated with a lower recurrence of infection than static spacers at a comparable mean duration of
follow-up. LEVEL OF EVIDENCE: IV
Telethermographic findings after uncomplicated and septic total knee replacement
No full textThermal imaging with infrared thermography is a noninvasive approach to monitoring surgical site healing and detecting septic complications. The aim of this study was to set reference values for telethermographic patterns of wound healing after total knee replacement (TKR) not complicated by infection and to compare them against thermograms from patients with knee prosthesis infection.
Forty consecutive patients operated for TKR underwent telethermography of the
operated and the contralateral knee before and up to 12 months after
uncomplicated surgery. The imaging data sets were then compared against those
obtained starting 8months after TKR in 15 other patients with diagnosed
periprosthetic infection. Presurgical assessment thermograms showed no difference between the affected and the healthy knees. At assessment 3days postoperative, the temperature of the operated knee had increased markedly, with a peak differential temperature (operated minus non-operated knee joint temperature) of 3.4±0.7°C; measurement at 90 days after surgery showed a return to baseline knee joint temperature in the patients with uncomplicated surgery. In the patients
with septic complications, the mean differential temperature was 1.6±0.6°C
(range, 1.1-2.5°C). Thermal imaging showed a measurable, reproducible
telethermographic pattern of surgical site healing in patients with uncomplicated TKR and an elevated mean differential temperature >1.0°C in those with persistent prosthesis infection
Does a thrombin-based topical haemostatic agent reduce blood loss and transfusion requirements after total knee revision surgery? A randomized, controlled trial
No full textPurpose The aim of the present study was to assess the efficacy of a thrombin-based topical haemostatic in reducing blood requirements after total knee replacement (TKR) revision surgery. Methods This prospective, randomized, controlled study was designed to evaluate the haemostatic efficacy and safety of a thrombin-based topical haemostatic (Floseal) versus standard treatment in patients receiving total knee revision arthroplasty. The decrease in haemoglobin values postsurgery and the blood units transfused were recorded. The decision to transfuse was made by a surgeon blinded to the patient's group allocation. Results Forty-eight patients were enroled in the study; twenty-four patients each were randomized to the treatment and control groups, respectively. The median decrease in haemoglobin concentration on the first postoperative day was 2.2 g/dL in the treatment group and 2.7 g/dL in the control group. A significant reduction in units of blood transfused was also observed in the treatment group compared with the control group [1.1 ± 1.13 (range 0-4) vs. 1.9 ± 1.41 (range 0-5) blood units; P = 0.04]. No major treatment-related adverse events were recorded in the study. Conclusions This study shows that a thrombin-based topical haemostatic reduces the need for blood transfusion in TKR revision surgery. Clinical relevance A thrombin-based topical haemostatic agent can be an appropriate solution to enhance haemostasis and vessel sealing at the operative site in TKR revision surgery, in order to reduce the need for blood transfusion after surgery. Level of evidence II
Bone and joint infections in adults: a comprehensive classification proposal
No full textTen currently available classifications were tested for their ability to describe a continuous cohort of 300 adult patients affected by bone and joint infections. Each classification only focused, on the average, on 1.3 ± 0.4 features of a single clinical condition (osteomyelitis, implant-related infections, or septic arthritis), being able to classify 34.8 ± 24.7% of the patients, while a comprehensive classification system could describe all the patients considered in the study. RESULT AND CONCLUSION: A comprehensive classification system permits more accurate classification of bone and joint infections in adults than any single classification available and may serve for didactic, scientific, and clinical purposes
A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis : a retrospective comparative study
No full textThe treatment of chronic osteomyelitis often includes surgical debridement and filling the resultant void with antibiotic-loaded polymethylmethacrylate cement, bone grafts or bone substitutes. Recently, the use of bioactive glass to treat bone defects in infections has been reported in a limited series of patients. However, no direct comparison between this biomaterial and antibiotic-loaded bone substitute has been performed. In this retrospective study, we compared the safety and efficacy of surgical debridement and local application of the bioactive glass S53P4 in a series of 27 patients affected by chronic osteomyelitis of the long bones (Group A) with two other series, treated respectively with an antibiotic-loaded hydroxyapatite and calcium sulphate compound (Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded demineralised bone matrix (Group C; n = 22). Systemic antibiotics were also used in all groups. After comparable periods of follow-up, the control of infection was similar in the three groups. In particular, 25 out of 27 (92.6%) patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out of 22 (86.3%) in Group C showed no infection recurrence at means of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up, respectively, while Group A showed a reduced wound complication rate. Our results show that patients treated with a bioactive glass without local antibiotics achieved similar eradication of infection and less drainage than those treated with two different antibiotic-loaded calcium-based bone substitutes
Cementless modular intramedullary nail without bone-on-bone fusion as a salvage procedure in chronically infected total knee prosthesis : long-term results
No full textPurpose: Our purpose was to evaluate long-term results of two-stage cementless intramedullary nailing without achieving bone-to-bone fusion for treating chronically infected total knee arthroplasty (TKA). Methods: Thirty-eight patients treated according to the same protocol were retrospectively evaluated for clinical, functional, laboratory and radiological outcomes. Results: Spacer exchange was necessary for infection persistence in one case. At a minimum two year follow-up, 34 patients (89.5 %) showed no infection recurrence; among these 34 patients, 29 (85.3 %) reported no or moderate pain [visual analogue scale (VAS) ≤3]; mild to moderate handicap (Lequesne Algofunctional Index < 7.5) was observed in 18 patients (52.9 %). No patient underwent revision for aseptic loosening, and no nail breakage was observed. Conclusions: Two-stage cementless intramedullary nailing without achieving bone-to-bone fusion is a viable option for treating chronically infected TKA in selected, complex cases
Antibacterial finishing reduces hospital textiles contamination. An experimental study
No full textIntroduction and methods Contaminated dressings are particularly
suitable for growth of microorganisms and a wellknown
source of bacterial spreading in the hospital environment.
This study evaluates the bacterial contamination of
white coats and surgical gowns and drapes treated with a
novel antibacterial finishing technology of hospital textiles.
Bacterial contamination rates of untreated white coats and
surgical gowns and drapes were compared to treated textiles.
In vitro determination of antibacterial activity against reference
bacterial strains and clinical isolates was performed
according to the European guideline EN ISO 20645. Efficacy
of the treatment was verified in clinical setting by comparing
the amount of bacteria isolated from treated and untreated
textiles used for clinical and surgical activities.
Result and conclusion Treated textiles demonstrated in vitro
activity against most of the tested microorganisms with the
exception of Pseudomonas aeruginosa. Bacterial contamination
was markedly lower for treated white coats after
1 week of use and for surgical gowns and textiles at the
end of surgery when compared to untreated dressings and
textiles used in the same conditions. The tested treatment
proved to be able to reduce bacterial contamination of
hospital textiles both in vitro and in the clinical and surgical
settings
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