Microbiología de las infecciones periprotésicas de rodilla en Hospital Regional de Talca / Microbiology of periprosthetic knee infections in Regional Hospital

Introduction: Periprosthetic infection (PPI) is one of the most devastating complications of total knee arthroplasty (TKA). The incidence described in the literature is 2.4% and the most frequently isolated bacteria are Staphylococcus Aureus and Staphylococcus Coagulase-Negative (Gram positive). Polymicrobial infections represent between 10 to 37% and negative cultures between 7 to 15%. Methodology: Descriptive and retrospective study that consisted of reviewing the TKA database of the Regional Hospital of Talca during the 2018-2020 period, where knee PPIs were identified according to the diagnostic criteria validated in 2018. The cultures of patients diagnosed with PPI were reviewed, analyzing the antibiogram and resistance profile. Results: During 2018-2020, 459 TKAs were performed in our center, diagnosing 30 PPIs of the knee. 47% of PPIs were acute and 53% chronic. The results of the cultures were negative in 26.6%, 23.3% Methicillin Sensitive Staphylococcus Aureus; 13.3% Methicillin Resistant Staphylococcus Epidermidis and 13.3% of the cultures were polymicrobial. Discussion: Highlights the high resistance to methicillin, especially of Staphylococcus Epidermidis. This opportunistic pathogen has the ability to form a biofilm and, thanks to its genomic flexibility, rapidly acquires resistance to antibiotics. Polymicrobial infections have a synergistic effect that favors the persistence of the infection, which is why they will require a greater number of surgeries and prolonged antibiotic therapy. Pruebas especiales como la sonicación podrían aumentar las posibilidad de identificar al microorganismo. Conclusion: In these three years of follow-up, the PPI rate has been higher than reported annually in the literature. Gram-positive microorganisms continue to predominate, but with an increase in the rate of resistant to methicillin. Also, highlight the number of negative cultures. There would be a possible benefit theoretical in optimizing antibiotic prophylaxis in view of the large percentage of methicillin resistance and in seeking new ways to reduce negative cultures.

Tratamiento mínimamente invasivo/percutáneo de fracturas de pilón tibial con asistencia artroscópica en Hospital Regional de Talca / Minimally invasive/percutaneous treatment of tibial pilon fractures with arthroscopic assistance at the Regional Hospital

Tibial pilon fractures are a complex injury to treat due to the great involvement of soft and bone tissues. The classic surgical treatment is based on open reduction with internal fixation (ORIF), adding morbidity to the soft tissues, increasing the risk of complications. This has motivated the development of minimally invasive and/or percutaneous techniques to reduce complications, and with the advent of arthroscopy, achieve anatomical reductions. METHODS: A retrospective observational study of twelve patients with tibial pilon fractures who were treated in our center with minimally invasive and/ or percutaneous osteosynthesis with arthroscopic support was carried out between January 2019 and June 2021. Fractures were characterized using the AO/OTA classification for tibial pilon. Age, sex, fracture mechanism, exposure and initial management in the emergency department (cast immobilization or external fixation), definitive treatment, complications and clinical and functional evaluation twelve months after definitive osteosynthesis. For this last point, plantar flexion, dorsiflexion and the AOFAS and FAOS Score were measured. RESULTS: The operated patients were 12, 8 were men (67%) and 4 were women (33%). The average age was 49 (17-68) years. The definitive treatment was carried out after an average of 8 days (5-12 days). Surgical treatment schemes were as follows: percutaneous osteosynthesis with medial anatomical plate and arthroscopic support (OPAA), minimally invasive osteosynthesis with cannulated screws and arthroscopic support (OMIAA) and osteosynthesis with external circular guide and arthroscopic support (OTCAA). In the AOFAS Score, three patients had excellent results (≥ 90 points), 6 patients had good results (≥ 80 points) and 3 patients had acceptable results (≥ 70 points). In the FAOS Score, eight patients had over 80% (good results) and 4 patients had over 60% (accep - table results). DISCUSSION: Historically, tibial pilon fractures have been considered non-reconstructable and with poor long-term results. Initially this paradigm changed with the principles of Rüedi for the reconstruction of the tibial pilon and improve the results. ORIF has been widely used until today, it allows achieving an anatomical joint reduction, it allows to give stability and length to the fibula, graft contribution and sta - bilization with the medial plate. Today this concept is changing again, since the emphasis is on the care of the soft tissues to allow a better recovery of the patient and reduce the complications of the classic approach, it is in this context that the appearance of minimally invasive and/or percutaneous techniques with arthroscopic assistance has allowed us to have excellent functional and clinical results with less da - mage to the soft tissues. CONCLUSION: The proper management and care of the soft tissues in a high-energy fracture of the tibial pilon is essential to obtain favorable clinical results and thus achieve restoration of ankle function. Percutaneous and minimally invasive management has optimized management of the tibial pilon, redu - cing the rates of complications, amputation, and pri - mary arthrodesis.

Ventana cortical anterior para extracción de vástago en revisión de artroplastia total de cadera: una alternativa a la osteotomía trocantérica extendida / Anterior cortical window for stem extraction in total hip arthroplasty revision: an alternative to extended trochanteric osteotomy

Total hip arthroplasty (THA) is a safe and effective procedure in patients with end-stage ostheoarthritis. In the last years the indication for THA is increasingly in younger patients, associated with rising of life expectancy, this imply an increase in revision surgeries for various causes such as: aseptic loosening, fractures and infections. In this context and in view of the need to replace the femoral component, alternatives to the classic extended trochanteric osteotomy (ETO) arise, such as the anterior cortical window (ACW), which allows the rate of complications to be reduced with excellent results. We present the case of a 51-year-old patient who sustained one episode of dislocation, who required revision surgery due to aseptic loosenig, where the ACW was used for the extraction of the stem. In addition, a review of the literature was made to show advantages and complications regarding ETO.

Artroplastia total de cadera bilateral en un tiempo: una opción quirúrgica para pacientes con coxartrosis severa bilateral / Simultaneous bilateral total hip arthroplasty: a surgical option for patients with several bilateral hip osteoarthritis

Total hip arthroplasty is a successful procedure with high rates of functional satisfaction and pain relief. A large number of patients with bilateral hip pathology will require both hip joint replacement, from there born the inquietude to knowing benefits and disadvantage of bilateral simultaneous hip arthroplasty. We present a female patient case who developed bilateral hip osteoarthritis secondary to development dysplasia of the hip which was surgically managed with bilateral arthroplasty at one time. We show a follow-up report of the case and a review of the literature to know the main advantages of this new current of hip arthroplasty in patients with bilateral hip pathology