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Article in Chinese | WPRIM | ID: wpr-879425


OBJECTIVE@#To analyze and compare the clinical efficacy of different types of surgical treatment of periprosthetic femoral fracture(PFF) after hip arthroplasty (HA).@*METHODS@#From September 2010 to September 2016, 47 patients (47 hips) with periprosthetic fractures after total hip arthroplasty were retrospectively analyzed, including 13 males and 34 females. According to Vancouver classification, there were 2 patients with type AG, 17 patients with type B1, 19 patients with type B2, 7 patients with type B3 and 2 patients with type C. The age of patients ranged from 56 to 94 (71.5±8.3) years. After admission, nutritional risk screening (NRS2002) was used to assess the nutritionalstatus of the patients. Eighteen patients (38%) had malnutrition risk (NRS>3 points). After admission, the patients were given corresponding surgical treatment according to different types. Intraoperative blood loss was recorded. Harris score was used to evaluate the hip function. VAS pain score was performed on admission and after operation.@*RESULTS@#All the 47 patients were followed up for 19 to 62 (34±11) months. The Harris scores were (41.8±12.1) and (89.0±2.6) respectively before and 1 year after operation, and the difference was statistically significant (@*CONCLUSION@#The treatment of hip periprosthetic fracture patients should be based on the general situation of patients, imaging data, intraoperative correction classification, etc. to develop individualized treatment plan in line with patients. For patients with preoperative malnutrition risk, preoperative nutritional intervention may reduce intraoperative bleeding.

Aged , Aged, 80 and over , Arthroplasty, Replacement, Hip/adverse effects , Female , Femoral Fractures/surgery , Fracture Fixation, Internal , Hip Prosthesis , Humans , Male , Middle Aged , Periprosthetic Fractures/surgery , Reoperation , Retrospective Studies , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-888330


OBJECTIVE@#To investigate the effect of different proximal femoral shapes on leg length discrepancy(LLD) after total hip arthroplasty(THA).@*METHODS@#Total 131 patients with osteoarthritis or osteonecrosis received unilateral biological total hip arthroplasty from June 2013 to June 2019. All patients' age, sex, side and pelvis anteroposterior digital radiography were retraspectively analyzed. There were 69 males and 62 females, 57 cases of left hip and 74 cases of right hip. The age ranges from 25 to 89 with an average age of 62 years. There were 48 cases of osteoarthritis and 83 cases of osteonecrosis. In this study, femoral cortical index (FCI) was used as the classification of proximal femoral shape, and bilateral lower limb length differences were measured by preoperative and postoperative pelvis anteroposterior digital radiography. Grouping according to FCI:> 0.6 was Dorr A group, 0.5 to 0.6 was Dorr B group, 0.6, the postoperative LLD was 6.30 mm (IQR 1.00 to 10.95 mm). When FCI was 0.5 to 0.6, the postoperative LLD was 5.85 mm(IQR-0.55 to 8.90 mm). FCI<0.5, the postoperative LLD was 1.95 mm(IQR -2.50 to 6.68 mm). LLD comparison of different proximal femoral shape was statistically significant (@*CONCLUSION@#High FCI increases the risk of lower extremity prolongation after surgery on the affectedside, while low FCI reduces the risk of lower extremity prolongation after surgery on the affected side. The surgeon can assess the shape of the proximal femur of the patient preoperatively and inform the patient in advance of possible changes in leg length of both lower extremities after total hip replacement.

Arthroplasty, Replacement, Hip/adverse effects , Female , Femur/surgery , Humans , Leg , Leg Length Inequality/etiology , Male , Middle Aged , Retrospective Studies
Chinese Medical Journal ; (24): 1610-1615, 2021.
Article in English | WPRIM | ID: wpr-887581


BACKGROUND@#Perioperative neurocognitive disorders (PND) are a series of severe complications in the perioperative and anesthetic periods with a decline in memory, execution ability, and information processing speed as the primary clinical manifestation. This study aimed to evaluate the impact of edaravone (EDA) on PND and peripheral blood C-X-C motif chemokine ligand 13 (CXCL13) levels in elderly patients with hip replacement.@*METHODS@#A total of 160 elderly patients undergoing hip arthroplasty in Affiliated Dongguan People's Hospital of Southern Medical University (from March 2016 to March 2018) were randomly and double-blindly categorized into an EDA group and a control group (CON). Group EDA was administered intravenously EDA 30 min before surgery, and group CON was administered intravenously saline. The cognitive function of the two groups was evaluated 1-day before the operation and at 1 and 12 months after surgery, and the incidence of post-operative delirium was tested on days 1, 3, and 7 after surgery using the Chinese version of the confusion assessment method. Serum CXCL13 and interleukin (IL)-6 concentrations were measured before anesthesia, during surgery (30 min after skin incision), and on days 1, 3, and 7 after surgery. The continuous variables in accordance with normal distribution were tested using the Student's t test, the continuous variables without normal distribution using the Mann-Whitney U test, and categorical variables by the χ2 test or Fisher exact test.@*RESULTS@#The incidence of post-operative delirium within 7 days after surgery was significantly higher in group CON than that in group EDA (31.3% vs. 15.0%, t = -5.6, P < 0.001). The modified telephone interview for cognitive status and activities of daily life scores were significantly higher in the group EDA than those in the group CON at 1 month (39.63 ± 4.35 vs. 33.63 ± 5.81, t = -2.13, P < 0.05 and 74.3 ± 12.6 vs. 61.2 ± 13.1, t = -1.69, P < 0.05) and 12 months (40.13 ± 5.93 vs. 34.13 ± 5.36, t = -3.37, P < 0.05 and 79.6 ± 11.7 vs. 65.6 ± 16.6, t = -2.08, P < 0.05) after surgery; and the incidence of neurocognitive dysfunction was significantly lower in the group EDA than that in the group CON (P < 0.05). Serum CXCL13 and IL-6 concentrations were significantly lower in the group EDA than those in the group CON during and after surgery (P < 0.05).@*CONCLUSION@#EDA can significantly reduce the serum concentrations of CXCL13 and IL-6 and improve the PND of patients.

Aged , Arthroplasty, Replacement, Hip/adverse effects , Chemokines, CXC/drug effects , Delirium , Double-Blind Method , Edaravone , Humans , Ligands , Postoperative Complications
Chinese Medical Journal ; (24): 164-172, 2021.
Article in English | WPRIM | ID: wpr-878008


BACKGROUND@#Aspirin has demonstrated safety and efficacy for venous thromboembolism (VTE) prophylaxis following total hip arthroplasty (THA); however, inconsistent dose regimens have been reported in the literature. This study aimed to evaluate and compare the safety and efficacy of 100 mg aspirin twice daily with rivaroxaban in VTE prophylaxis following THA.@*METHODS@#Patients undergoing elective unilateral primary THA between January 2019 and January 2020 were prospectively enrolled in the study and randomly allocated to receive 5 weeks of VTE prophylaxis with either oral enteric-coated aspirin (100 mg twice daily) or rivaroxaban (10 mg once daily). Medication safety and efficacy were comprehensively evaluated through symptomatic VTE incidence, deep vein thrombosis (DVT) on Doppler ultrasonography, total blood loss (TBL), laboratory bloodwork, Harris hip score (HHS), post-operative recovery, and the incidence of other complications.@*RESULTS@#We included 70 patients in this study; 34 and 36 were allocated to receive aspirin and rivaroxaban prophylaxis, respectively. No cases of symptomatic VTE occurred in this study. The DVT rate on Doppler ultrasonography in the aspirin group was not significantly different from that in the rivaroxaban group (8.8% vs. 8.3%, χ2 = 0.01, P = 0.91), confirming the non-inferiority of aspirin for DVT prophylaxis (χ2 = 2.29, P = 0.01). The calculated TBL in the aspirin group (944.9 mL [658.5-1137.8 mL]) was similar to that in the rivaroxaban group (978.3 mL [747.4-1740.6mL]) (χ2 = 1.55, P = 0.12). However, there were no significant inter-group differences in HHS at post-operative day (POD) 30 (Aspirin: 81.0 [78.8-83.0], Rivaroxaban: 81.0 [79.3-83.0], χ2 = 0.43, P = 0.67) and POD 90 (Aspirin: 90.0 [89.0-92.0], Rivaroxaban: 91.5 [88.3-92.8], χ2 = 0.77, P = 0.44), the incidence of bleeding events (2.9% vs. 8.3%, χ2 = 0.96, P = 0.33), or gastrointestinal complications (2.9% vs. 5.6%, χ2 = 1.13, P = 0.29).@*CONCLUSION@#In terms of safety and efficacy, the prophylactic use of 100 mg aspirin twice daily was not statistically different from that of rivaroxaban in preventing VTE and reducing the risk of blood loss following elective primary THA. This supports the use of aspirin chemoprophylaxis following THA as a less expensive and more widely available option for future THAs.@*TRIAL, ChiCTR18000202894;

Anticoagulants , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee , Aspirin/therapeutic use , Humans , Rivaroxaban/therapeutic use , Venous Thromboembolism/prevention & control
Acta ortop. mex ; 34(1): 47-52, ene.-feb. 2020. graf
Article in English | LILACS | ID: biblio-1345085


Abstract: Introduction: Anterior dislocation is a rare complication of total hip arthroplasty (THA). There exist only three cases in the literature. None of them report disassembly of the prosthesis components. We present a morbidly obese woman who suffered an irreducible obturator dislocation of an infected total hip arthroplasty (THA), due to uncontrolled adduction during an early debridement surgery. Following unsuccessful closed reduction attempts, a Vancouver B2 periprosthetic fracture and disassembly of the prosthetic components were observed. Two-stage revision THA was necessary to resolve the infection and restore hip functionality. In obturator dislocation, the femoral head prosthetic can be trapped in the obturator foramen, and this may disassemble the prosthesis components during reduction maneuvers; there's also risk of periprosthetic fracture. This mandate an open reduction of the joint. Patient obesity could be a determining factor for this rare type of hip arthroplasty dislocation. Obturator dislocation is an extremely rare complication of the total hip arthroplasty, whose reductions should be handled with caution given the risks of periprosthetic fractures. In most cases, an open reduction of the joint is required. Clinical importance: Our work is likely to be of great interest because it offers tips for the management of this rare complication based on our experience.

Resumen: Introducción: La luxación anterior es una complicación poco frecuente de la artroplastia total de cadera (ATC). Sólo existen tres casos en la literatura. Ninguno de ellos informa del desmontaje de los componentes de la prótesis. Presentamos el caso una mujer obesa que sufrió una luxación irreducible de una artroplastia total de cadera (THA), la cual estaba infectada, debido a la aducción no controlada durante una cirugía de desbridamiento temprano. Después de los intentos fallidos de reducción cerrada, se presentó una fractura periprotésica clasificada como Vancouver B2 y el desmontaje de los componentes protésicos. Ameritó cirugía de revisión en dos etapas, lo cual se realizó para resolver la infección y restaurar la funcionalidad de la cadera. En la luxación obturatriz, la cabeza femoral puede quedar atrapada en el agujero obturador y, como consecuencia, favorecer la disociación de los componentes protésicos al intentar la reducción, asimismo puede favorecer un brazo de palanca que produzca una fractura periprotésica. La obesidad puede ser un factor determinante para la producción de esta rara complicación. Por todo lo anterior, se recomienda considerar de entrada la reducción abierta. La luxación obturatriz es una complicación rara en la artroplastia total de cadera; su tratamiento puede ser difícil y asociarse a fracturas. La relevancia de este caso es que permite mostrar algunas estrategias de manejo para prevenir complicaciones catastróficas.

Humans , Female , Obesity, Morbid/surgery , Obesity, Morbid/complications , Arthroplasty, Replacement, Hip/adverse effects , Periprosthetic Fractures/surgery , Periprosthetic Fractures/etiology , Femoral Fractures/surgery , Hip Dislocation/surgery , Hip Dislocation/etiology , Hip Prosthesis/adverse effects , Reoperation
Article in Chinese | WPRIM | ID: wpr-879348


OBJECTIVE@#To evaluate the efficacy and safety of local application of tranexamic acid (TXA) in reducing perioperative blood loss in total hip arthroplasty via direct anterior approach (DAA).@*METHODS@#From July 2013 to September 2018, 46 patients with avascular necrosis of the femoral head were divided into tranexamic acid group (@*RESULTS@#The incision healed well and no obvious complications occurred in the two groups. All patients were followed up for 12 to 59 months(averaged 31.11 months). No hip pain was found in the follow-up patients. Hip joint function was improved effectively and no prosthesis loosening occurred. The total perioperative blood loss in tranexamic acid group and normal saline group was(740.09±77.14) ml and (1 069.07±113.53) ml respectively, 24 hours after operation, the drainage volume was (87.61±9.28) ml, (233.83±25.62) ml, the hidden blood loss was (409.65±38.01) ml and (588.33±57.16) ml. the difference of hemoglobin before and after operation was (24.78±2.19) g / L and (33.57±2.95) g / L, the difference was statistically significant (@*CONCLUSION@#local application of tranexamic acid in total hip arthroplasty through direct anterior approach can safely and effectively reduce perioperative blood loss, and does not increase the risk of thrombosis, and does not affect the normal recovery of joint function.

Aged , Antifibrinolytic Agents/therapeutic use , Antiviral Agents , Arthroplasty, Replacement, Hip/adverse effects , Blood Loss, Surgical/prevention & control , Female , Hepatitis C, Chronic , Humans , Male , Middle Aged , Safety , Tranexamic Acid/therapeutic use , Treatment Outcome
Article in Chinese | WPRIM | ID: wpr-879345


Periprosthetic infection after hip replacement is a clinical catastrophic disease, which often leads to the failure of the prosthesis. It needs the combination of systemic antibiotics to cure the infection, which brings huge burden to doctors and patients. There are strict indications for debridement and one-stage revision of the prosthesis, and few cases meet the requirements. The second revision is still the gold standard for the treatment of periprosthetic infection. It is suitable for all infection conditions and has a high success rate. On the second phase of renovation, the antibiotic sustained release system plays a key role, and the carrier of antibiotic sustained-release system is the focus of current research, including classic bone cement and absorbable biomaterials. Bone cement has strong mechanical strength, but the antibiotic release shows a sharp decline trend; the absorbable biomaterials can continuously release antibiotics with high concentration, but the mechanical strength is poor, so it could not use alone. The combination of bone cement and absorbable biomaterials will be an ideal antibiotic carrier. PMMA is the most commonly used antibiotic carrier, but the antibiotic release concentration is decreased sharply after 24 hours. It will be difficult to control the infection and increase the risk of bacterial resistance if it is lower than the minimum inhibitory concentration. The biodegradable materials can release antibiotics completely, with long release time and high concentration, but low mechanical strength. Antibiotic spacer plays an important role in the control of infection. In the future, how to further extend the antibiotic release time of antibiotic sustained-release system, increase the amount of antibiotic release and maintain the mechanical strength of the material will be studied.

Anti-Bacterial Agents/therapeutic use , Arthroplasty, Replacement, Hip/adverse effects , Bone Cements , Hip Prosthesis , Humans , Prosthesis-Related Infections/surgery , Reoperation
Article in Chinese | WPRIM | ID: wpr-879340


OBJECTIVE@#To investigate the influence of total hip arthroplasty on the changes of spine pelvic parameters in patients with hip spine syndrome.@*METHODS@#From January 2013 to October 2014, 22 patients (26 hips) with hip spine syndrome accompanied by necrosis of femoral head, hip osteoarthritis and congenital dysplasia of hip were treated with total hip arthroplasty. There were 12 males and 10 females with an average age of 58.4 years (range, 45 to 76 years). The course of disease was 1.5 to 25 years with an average of 12.8 years. Before and after the operation, the anteroposterior, full length radiographs of both lower limbs, thoracolumbar spine and pelvis in standing position were routinely taken. The balance parameters of spine pelvis coronal plane and sagittal plane before and after the replacement were measured. Visual analogue scale (VAS), Oswestry Disability Index (ODI) and Harris score were performed before and after the operation.@*RESULTS@#All cases were followed up for 21 to 52 (32±8) months. No infection, prosthesis subsidence, loosening, prosthesis dislocation were found in the last follow up. After total hip arthroplasty, sagittal vertical axis(SVA), thoracic kyphosis(TK), lumbar lordosis(LL), pelvic tilt (PT) were significantly reduced(@*CONCLUSION@#After total hip arthroplasty, the coronal and historical balance parameters of spine and pelvis are significantly improved, and the short term and medium-term effects are satisfactory.

Aged , Arthroplasty, Replacement, Hip/adverse effects , Female , Follow-Up Studies , Humans , Lumbar Vertebrae/surgery , Male , Middle Aged , Patients , Pelvis , Retrospective Studies , Spine
Rev. Assoc. Med. Bras. (1992) ; 65(7): 946-950, July 2019. tab
Article in English | LILACS | ID: biblio-1041046


SUMMARY A background of Pulmonary Hypertension (PH) indicates a progressive elevation of pulmonary vascular resistance, leading to overfilling, elevation of venous pressure, congestion in various organs, and edema in the venous system. This study aimed to investigate whether PH is a risk factor for deep vein thrombosis (DVT) of the lower extremities after hip and knee replacement surgery. METHODS A total of 238 patients who received joint replacement of lower extremities in our department of orthopedics from January 2009 to January 2012 were examined by echocardiography and Color Doppler flow imaging (CDFI) of the lower extremities. Based on pulmonary artery pressure (PAP), the patients were divided into a normal PAP group (n=214) and PH group (n=24). All the patients were re-examined by CDFI during post-operative care. RESULTS Among the 238 patients, 18 had DVT in the lower extremities after the operation. DVT total incidence rate was 7.56% (18/238). In the PH group, 11 patients had DVT (45.83%, 11/24), but in the normal PAP group, only 7 had DVT (3.27%, 7/214). The incidence of DVT was significantly lower in the normal PAP group than in the PH group (P<0.01). In addition, there was a positive correlation between PAP and the incidence of DVT. CONCLUSION PH could be a high-risk factor for the occurrence of DVT in patient's lower extremities after joint replacement surgeries.

RESUMO OBJETIVO A hipertensão pulmonar (HP) indica elevação progressiva da resistência vascular pulmonar, levando ao excesso de enchimento, elevação da pressão venosa, congestão em vários órgãos e edema no sistema venoso. Este estudo teve como objetivo investigar se a HP é um fator de risco para trombose venosa profunda (TVP) das extremidades inferiores após cirurgia de prótese de quadril e joelho. MÉTODOS Um total de 238 pacientes que receberam a substituição da articulação das extremidades inferiores em nosso departamento de ortopedia de janeiro de 2009 a junho de 2012 foi examinado por ecocardiograma e fluxo de imagem Doppler colorido (CDFI) dos membros inferiores. De acordo com a pressão arterial pulmonar (PAP), os pacientes foram divididos em grupo PAP normal (n=214) e grupo PH (n=24). Todos os pacientes foram reexaminados por CDFI durante os cuidados pós-operatórios. RESULTADOS Entre os 238 pacientes, 18 pacientes tiveram TVP nas extremidades inferiores após a operação. A taxa de incidência total de TVP foi de 7,56% (18/238). No grupo PH, 11 pacientes tiveram TVP (45,83%, 11/24), mas no grupo PAP normal, apenas sete pacientes tiveram TVP (3,27%, 7/214). A incidência de TVP foi significativamente menor no grupo PAP normal do que no grupo PH (P<0,01). Além disso, houve uma correlação positiva entre a PAP e a incidência de TVP. CONCLUSÃO A HP poderia ser um fator de alto risco para a ocorrência de TVP nas extremidades inferiores do paciente após cirurgias de substituição articular.

Humans , Male , Female , Aged , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Venous Thrombosis/etiology , Hypertension, Pulmonary/complications , Postoperative Complications/etiology , Reference Values , Echocardiography, Doppler , Retrospective Studies , Risk Factors , Venous Thrombosis/diagnostic imaging , Preoperative Period , Hip/blood supply , Hypertension, Pulmonary/diagnostic imaging , Knee/blood supply
Rev. chil. infectol ; 36(3): 265-273, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1013783


Resumen Introducción: Las infecciones de herida operatoria de pacientes intervenidos de artroplastía total de cadera, presentan una incidencia desde 2 a 5%, generando impacto en la estadía hospitalaria, uso de recursos, antibioterapia prolongada y secuelas temporales o definitivas. Objetivo: Generar un modelo predictivo para la infección de herida operatoria en pacientes intervenidos de artroplastía total de cadera, entre los años 2012 y 2014, en un hospital de alta complejidad. Material y Método: Cohorte de pacientes con artroplastía total de cadera. Se efectuó la descripción de las variables epidemiológicas y se generó un modelo predictivo por regresión logística. Resultados: Se analizaron 441 pacientes. El modelo predictivo obtenido incluyó las variables: días de estadía post operatoria (OR 1,11 IC95% [1,03-1,20]), transfusión de al menos una unidad de glóbulos rojos (OR 3,13 IC95% [1,17-10,86]), diagnóstico de depresión previo a la cirugía (OR 5,75 IC95% [1,32-25,32], incumplimiento del tiempo de administración de la antibioprofilaxis (OR 5,46 IC95% [1,68-17,78]; p < 0,001) y pseudo R2 = 0,2293. Punto de corte de "score" de 13 puntos con sensibilidad 44,4%, especificidad de 91,6%, LR (+) 5,29, LR (-) 0,61, considerando además la siguiente clasificación: 1 a 6 puntos "bajo riesgo", 7 a 12 puntos "mediano riesgo", 13 a 18 puntos "alto riesgo", desde 19 puntos como "máximo riesgo". Conclusión: El modelo presenta una buena capacidad de predicción de infección de herida operatoria y representa adecuadamente a la cohorte en estudio.

Introduction: Operative wound infections of patients undergoing total hip arthroplasty have an incidence from 2% to 5%, generating impact on hospital stay, resource use, prolonged antibiotic therapy, including temporary or definitive sequelae. Objective: To generate a predictive model for surgical wound infection in patients undergoing total hip arthroplasty between 2012 and 2014 at the High Complexity Hospital. Material and Method: Cohort of patients with total hip arthroplasty. A description of the epidemiological variables was made and a predictive model was generated by means of logistic regression. Results: 441 patients were analyzed. The predictive model obtained included the variables: days of post-operative stay (OR 1.11 IC95% [1.03 - 1.20]), transfusion of at least one unit of red blood cells (OR 3.13 IC95% [1.17 - 10.86]), diagnosis of previous depression to surgery (OR 5.75 IC95% [1.32 - 25.32], non-compliance with antibioprophylaxis administration time (OR 5.46 IC95% [1.68 - 17.78], P < 0.001) and pseudo R2 = 0.2293. Score point of 13 points with sensitivity 44.4%, specificity of 91.6%, LR (+) 5.29, LR (-) 0.61, 1 to 6 points "low risk", 7 to 12 points "medium risk", 13 to 18 points "high risk", from 19 points as "maximum risk". Conclusion: the model presents a good predictive capacity of operative wound infection and adequately represents the cohort under study.

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Surgical Wound Infection/prevention & control , Arthroplasty, Replacement, Hip/adverse effects , Models, Biological , Blood Transfusion , Logistic Models , Predictive Value of Tests , Retrospective Studies , Risk Factors , Sensitivity and Specificity , Arthroplasty, Replacement, Hip/psychology , Depression/complications , Length of Stay
An. bras. dermatol ; 94(3): 363-364, May-June 2019. graf
Article in English | LILACS | ID: biblio-1011113


Abstract: The authors report the case of a 62-year-old man with a history of total left hip arthroplasty nine years previously presenting with a large infiltrated plaque on the posterior area of the left thigh with three months of evolution without systemic symptoms or elevated inflammatory markers. Computed tomography of the left lower limb revealed a 12-centimeter linear extension of the lesion to the posterior part of the left proximal femur. Prosthesis joint infection, although rare, is a surgical complication to be taken into account, even if the surgery was performed many years before.

Humans , Male , Middle Aged , Suppuration/diagnosis , Arthroplasty, Replacement, Hip/adverse effects , Hip Prosthesis/adverse effects , Streptococcus agalactiae/isolation & purification , Suppuration/microbiology , Thigh , Biopsy , Tomography, X-Ray Computed , Femur
Einstein (Säo Paulo) ; 17(4): eAO4905, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019804


ABSTRACT Objective To compare analgesia and opioid consumption for patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Methods The medical records of patients undergoing unilateral total hip arthroplasty between January 1st, 2017 and March 31, 2018 were reviewed, and 238 patients were included in the study. The primary outcome was postoperative opioid consumption in the first 24 postoperative hours. Secondary outcomes were intraoperative, post anesthesia care unit, and 48-hour opioid consumption, postoperative pain Visual Analog Scale scores, and post-anesthesia care unit length of stay. Primary and secondary endpoint data were compared between patients undergoing primary total hip arthroplasty with preoperative posterior quadratus lumborum block with patients who did not receive quadratus lumborum block. Results For the patients who received quadratus lumborum block, the 24-hour total oral morphine equivalent (milligram) requirements were lower (53.82mg±37.41), compared to the patients who did not receive quadratus lumborum block (77.59mL±58.42), with p=0.0011. Opioid requirements were consistently lower for the patients who received quadratus lumborum block at each additional assessment time point up to 48 hours. Pain Visual Analog Scale scores were lower up to 12 hours after surgery for the patients who received a posterior quadratus lumborum block, and the post-anesthesia care unit length of stay was shorter for the patients who received quadratus lumborum block. Conclusion Preoperative posterior quadratus lumborum block for primary total hip arthroplasty is associated with decreased opioid requirements up to 48 hours, decreased Visual Analog Scale pain scores up to 12 hours, and shorter post-anesthesia care unit length of stay. Level of evidence: III

RESUMO Objetivo Comparar a analgesia e o uso de opioides em pacientes submetidos à artroplastia total do quadril primária com bloqueio pré-operatório do quadrado lombar posterior e pacientes que não receberam o bloqueio do quadrado lombar. Métodos Revisamos os prontuários de pacientes submetidos à artroplastia total do quadril unilateral entre 1º de janeiro de 2017 e 31 de março de 2018, e 238 pacientes foram incluídos no estudo. O desfecho primário foi o consumo de opioides no pós-operatório nas primeiras 24 horas. Os desfechos secundários foram consumo de opioide no intraoperatório, na sala de recuperação pós-anestésica e nas primeiras 48 horas, escores de Escala Visual Analógica de dor pós-operatória, e tempo de permanência na recuperação pós-anestésica. Os desfechos primário e secundários foram comparados entre os pacientes submetidos à artroplastia total do quadril primária com bloqueio pré-operatório do quadrado lombar posterior e aqueles que não receberam o bloqueio do quadrado lombar. Resultados Para o grupo que recebeu o bloqueio, as doses totais de morfina por via oral em 24 horas foram menores (53,82mg±37,41) em comparação ao grupo sem bloqueio (77,59mg±58,42), com p=0,0011. A utilização de opioides foi consistentemente menor para o grupo que recebeu o bloqueio em cada tempo adicional de avaliação até 48 horas. Os escores da Escala Visual Analógica até 12 horas após a cirurgia para os pacientes que receberam o bloqueio do quadrado lombar posterior e o tempo de permanência na sala de recuperação pós-anestésica foram menores para o grupo que recebeu o bloqueio. Conclusão O bloqueio anestésico do quadrado lombar posterior para artroplastia total do quadril primária está associado à diminuição do uso de opioides nas primeiras 48 horas, diminuição do escore de dor da Escala Visual Analógica em até 12 horas, e menor tempo de permanência na sala de recuperação pós-anestésica. Nível de evidência: III

Pain, Postoperative/drug therapy , Arthroplasty, Replacement, Hip/adverse effects , Analgesics/therapeutic use , Anesthetics, Local/therapeutic use , Pain, Postoperative/etiology , Time Factors , Anesthesia Recovery Period , Retrospective Studies , Abdominal Muscles/innervation , Dose-Response Relationship, Drug , Perioperative Period/methods , Pain Management , Analgesics/administration & dosage , Analgesics, Opioid/administration & dosage , Analgesics, Opioid/therapeutic use , Anesthesia, General , Anesthesia, Spinal , Anesthetics, Local/administration & dosage , Nerve Block/methods
Belo Horizonte; s.n; 2019. 89 p. graf, tab, ilus.
Thesis in Portuguese | LILACS, BDENF | ID: biblio-1010265


As cirurgias ortopédicas com uso de prótese são procedimentos utilizados para o tratamento de doenças em articulações. Embora seja um procedimento bastante utilizado, o paciente está sujeito as várias complicações e insucesso do tratamento. Entre essas complicações, a infecção de sítio cirúrgico (ISC) é uma das mais prevalentes, com incidências variando entre 1,4% e 12,6%. Para prevenir essa afecção, o acompanhamento da incidência e a monitorização de fatores de risco permitirão adoções de práticas de prevenção baseadas em evidências, visando uma assistência mais segura. Este estudo é uma coorte não concorrente de 149 pacientes submetidos à artroplastia total de quadril (ATQ) e artroplastia total de joelho (ATJ). O objetivo geral foi analisar os aspectos epidemiológicos das infecções de sitio cirúrgico nos pacientes submetidos à cirurgia ortopédica, no período de 2015 a 2018 em um hospital de grande porte de Belo Horizonte, Minas Gerais. Os objetivos específicos foram estimar a incidência das infecções de sítio cirúrgico; estimar a incidência de infecção de sítio cirúrgico (ISC) por topografia; identificar os fatores de risco associados à infecção ortopédica; identificar os microorganismos responsáveis pelas infecções e propor modelo preditivo multivariado. Na análise univariada, aplicou-se o teste não paramétrico de Mann Whitney. E para verificar a hipótese de associação entre as variáveis categóricas com os grupos, aplicouse o teste exato de Fisher. Na análise multivariada, aplicou-se o modelo de Regressão Logística (p-valor<0,05.) Foram notificadas seis ISC, com taxa global de 4,03%, todas caracterizadas como superficiais. Nos pacientes que foram submetidos à ATJ, a incidência de ISC foi de 2,94% e os que realizaram ATQ, 4,94%. Os fatores de risco identificados para ISC ortopédicas foram idade e hipertensão arterial sistêmica. Os microorganismos isolados foram Enterobacter cloacae, Acinetobacter baumannii e Stenotrophomonas maltophilia. As taxas de ISC encontradas neste estudo foram maiores que as recomendadas pelo NHSN/CDC.(AU)

Orthopedic surgeries with prosthesis are procedures used for the treatment of diseases in joints. Although it is a widely used procedure, the patient is subject to various complications and treatment failure. Among these complications, surgical site infection (SSI) is one of the most common, with incidence varying between 1.4% and 12.6%. To prevent this condition, monitoring incidence and monitoring risk factors will allow adoptions of evidencebased prevention practices for safer care. This study is a non-concurrent cohort of 149 patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). The general objective was to analyze the epidemiological aspects of surgical site infections in patients submitted to orthopedic surgery from 2015 to 2018 at a large hospital in Belo Horizonte, Minas Gerais. The specific objectives were to estimate the incidence of surgical site infections; to estimate the incidence of surgical site infection (SSI) by topography; identify the risk factors associated with orthopedic infection; identify the microorganisms responsible for infections and propose a multivariate predictive model. In the univariate analysis, the nonparametric Mann Whitney test was applied. And to verify the hypothesis of association between the categorical variables with the groups, Fisher's exact test was applied. In the multivariate analysis, the Logistic Regression model was applied (p-value <0.05). Six SSIs were reported, with an overall rate of 4.03%, all characterized as superficial. In patients who underwent TKA, the incidence of SSI was 2.94% and those who undergoing TKA, 4.94%. The risk factors identified for orthopedic SSIs were age and systemic arterial hypertension. The isolated microorganisms were Enterobacter cloacae, Acinetobacter baumannii and Stenotrophomonas maltophilia. The SSI rates found in this study were higher than those recommended by the NHSN / CDC.(AU)

Humans , Male , Female , Middle Aged , Surgical Wound Infection/epidemiology , Risk Factors , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Prostheses and Implants/adverse effects , Surveys and Questionnaires , Retrospective Studies , Enterobacter cloacae , Academic Dissertation , Stenotrophomonas maltophilia , Acinetobacter baumannii
Acta ortop. mex ; 32(4): 193-197, Jul.-Aug. 2018. tab
Article in English | LILACS | ID: biblio-1124093


Abstract: Background: Rheumatoid arthritis is a chronic inflammatory disease characterized by polyarthritis with progressive articular wear, immunologic abnormalities and increasing physical limitation. Surgical correction with hip replacement comes as a successful solution for patients with advanced articular destruction. Following intervention, surgical site infection (SSI), venous thromboembolism, sepsis, renal and major cardiovascular complications are among the most cited in the literature. No consensus exists as to the detection of preoperative hypoalbuminemia in patients with rheumatoid arthritis. Methods: This study retrospectively evaluated the preoperative serum albumin of 75 patients with rheumatoid arthritis and analyzed its relevance in terms of appearance of postoperative complications with a six-month follow-up. Complications in the group of patients with low serum albumin and the group of patients with normal serum albumin were reviewed to identify the effect of each variable. Odds ratio for each variable was calculated (hospital readmission, surgical site infection, renal and cardiac complications, non-infectious wound complications and the presence of residual hip pain), as well as p-value and confidence intervals. Results: Surgical site infection showed a statistically significant relation with low serum albumin (OR: 6.125, p = 0.018) as did non-infectious wound complications (OR: 3.714, p = 0.026) and residual hip pain (OR: 3.149, p = 0.022). Conclusion: Preoperative low serum albumin has a direct relation with the rate of postoperative complications including SSI, non-infectious wound complications (seroma formation, wound dehiscence) and residual hip pain. Preoperative serum albumin is a reliable marker of nutrition, which may establish preventive strategies to reduce postoperative complications in patients with rheumatoid arthritis.

Resumen: Introducción: La artritis reumatoide es una enfermedad inflamatoria crónica con desgaste articular progresivo, anomalías inmunológicas y aumento de la limitación física. La corrección quirúrgica con el reemplazo de la cadera es una solución a la destrucción articular avanzada. Después de la intervención, la infección del sitio quirúrgico (SSI), el tromboembolismo venoso, la sepsis y las complicaciones cardiovasculares o renales se encuentran entre las más citadas en la literatura. No existe consenso en cuanto a la detección de hipoalbuminemia preoperatoria en pacientes con artritis reumatoide. Métodos: Estudio retrospectivo evaluando la albúmina de suero preoperatoria de 75 pacientes con artritis reumatoide, se analizó su importancia en términos de complicaciones postoperatorias en los primeros seis meses de seguimiento. Las complicaciones en el grupo de pacientes con albúmina de suero baja y el grupo de pacientes con albúmina de suero normal fueron repasadas para identificar el efecto de cada variable. Se calculó el odds ratio para cada variable (reingreso hospitalario, infección del sitio quirúrgico, complicaciones renales y cardíacas, complicaciones no infecciosas de la herida y presencia de dolor de cadera residual), así como el valor p y los intervalos de confianza. Resultados: La infección del sitio quirúrgico demostró una relación estadística significativa con la albúmina de suero baja (o: 6.125, p = 0.018) al igual que complicaciones no infecciosas de la herida (o: 3.714, p = 0.026) y dolor residual de la cadera (o: 3.149, p = 0.022). Conclusión: La albúmina sérica baja preoperatoria tiene una relación directa con la tasa de complicaciones postoperatorias: infección, formación de seromas, dehiscencia de la herida y dolor residual.

Humans , Arthritis, Rheumatoid/complications , Surgical Wound Infection/diagnosis , Surgical Wound Infection/blood , Serum Albumin/analysis , Arthroplasty, Replacement, Hip/adverse effects , Postoperative Complications , Retrospective Studies , Risk Factors
Rev. Asoc. Argent. Ortop. Traumatol ; 82(4): 317-320, dic. 2017. []
Article in Spanish | LILACS, BINACIS | ID: biblio-896275


Se presenta un paciente con lesión vascular iatrogénica de la arteria circunfleja femoral externa luego de una artroplastia total de cadera. Después de la intervención, el paciente presentó anemia importante en repetidas ocasiones con dolor en el muslo y requirió cirugía para evacuar un hematoma. Sin embargo, la angiografía por tomografía computarizada realizada en dos ocasiones fue negativa para sangrado activo. Finalmente se diagnosticó lesión de esta arteria mediante arteriografía, y el paciente fue sometido a cirugía endovascular. Destacamos la importancia del cuidado en la manipulación del miembro intervenido y los objetos usados. Así mismo, la sospecha y los medios diagnósticos adecuados son fundamentales, ya que, ante una clínica poco definida, pruebas comunes negativas y la ausencia de un sangrado activo importante, puede pasar inadvertida una lesión vascular que pone en riesgo la vida del paciente si no se resuelve. También se pone de relevancia el avance en el tratamiento de estas lesiones mediante las técnicas endovasculares que reducen la morbimortalidad respecto a las técnicas clásicas de cirugía abierta. Nivel de Evidencia: IV

We present a patient with iatrogenic vascular lesion of the external circumflex femoral artery following a total hip arthroplasty. After surgery the patient presented important anemia in repeated occasions, with thigh pain requiring evacuation of the hematoma. Nevertheless two angio-CTs were negative for active bleeding. Finally the lesion was diagnosed by arteriography, and it was treated with endovascular surgery. We emphasize the importance of the care during the manipulation of the limb and the objects used. We also explain how the diagnosis was suspected even though the commonly used diagnostic tools did not reveal the diagnosis, and there was no active bleeding, increasing the chances of overcoming the diagnosis of a lesion that is potentially life threatening if it is not resolved. We also highlight the advances in the treatment of these lesions with endovascular techniques, which reduce morbidity and mortality when compared with the classic open surgery. Level of Evidence: IV

Aged , Postoperative Complications , Arthroplasty, Replacement, Hip/adverse effects , Femoral Artery/injuries , Vascular System Injuries
Clinics ; 72(12): 729-736, Dec. 2017. tab, graf
Article in English | LILACS | ID: biblio-890699


OBJECTIVES: This study examined periarticular multimodal drug injection and the use of nonsteroidal anti-inflammatory drugs for an early analgesic effect after total knee arthroplasty and total hip arthroplasty. Patient satisfaction and benefits from the treatment were also assessed. METHODS: A total of 110 patients who were scheduled to undergo total knee arthroplasty and 86 patients who were scheduled to undergo total hip arthroplasty were divided into two groups, the study group and the control group. The study group received a periarticular multimodal drug injection during surgery. The control group received an equal volume of normal saline. All patients received an analgesia pump and a moderate dose of nonsteroidal anti-inflammatory drugs. Resting and motion Numeric Rating Scale scores, the Western Ontario and McMaster Universities Arthritis Index, knee or hip joint range of motion, length of postoperative hospital stay, patient satisfaction, total nonsteroidal anti-inflammatory drug consumption and side effects were recorded. RESULTS: Both study groups exhibited significant improvement in pain Numeric Rating Scale scores during rest and exercise several days after the surgery. The range of joint motion was greater in the study group, and the length of postoperative hospital stay was shorter than that in the control group. Patients in the study group consumed fewer nonsteroidal anti-inflammatory drugs and reported greater satisfaction with surgery. CONCLUSION: Intraoperative periarticular multimodal drug injection significantly relieved pain after surgery and reduced nonsteroidal anti-inflammatory drug consumption. These patient had a better postoperative experience, including satisfaction and rehabilitation.

Humans , Male , Female , Adult , Young Adult , Pain, Postoperative/drug therapy , Anti-Inflammatory Agents, Non-Steroidal/administration & dosage , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Analgesics, Opioid/administration & dosage , Morphine/administration & dosage , Pain, Postoperative/etiology , Case-Control Studies , Pain Management , Analgesia , Injections, Intra-Articular
Rev. Assoc. Med. Bras. (1992) ; 63(3): 248-251, Mar. 2017. tab, graf
Article in English | LILACS | ID: biblio-956441


Summary Introduction: Delirium is a common disorder that can potentiate mortality and comorbidity rates of patients hospitalized in intensive care units. Patients undergoing major orthopedic surgeries, such as knee and hip arthroplasty, are particularly vulnerable as they often have multiple risk factors for this disorder. Method: Descriptive study of the incidence of delirium in patients treated with total knee and hip arthroplasty, given the advanced age and comorbidities in this population. We evaluated the medical records of patients who had previously undergone the designated surgeries for identification of postoperative delirium. Results: We observed in this study an incidence of 8.92% of delirium, mostly affecting females with a mean age of 73 years and hypertension. Conclusion: The incidence of delirium in our study is similar to that observed in the general population, according to the literature. We found no correlation with sleep disorders, smoking or diabetes mellitus in this study, even though the importance of these factors for the onset of delirium is well-established in the literature.

Resumo Introdução: Delirium é um transtorno comum e que pode potencializar a taxa de mortalidade e de comorbidade de pacientes internados em unidades de terapia intensiva. Dentre esses pacientes, aqueles submetidos a cirurgias ortopédicas de grande porte, como as artroplastias de joelho e quadril, apresentam especial vulnerabilidade, já que em muitos casos os pacientes são portadores de diversos fatores de risco para esse transtorno. Método: Este é um estudo descritivo retrospectivo da incidência de delirium em pacientes submetidos a artroplastia total de quadril e joelho, tendo em vista a idade avançada e a presença de comorbidades nessa população. Avaliamos o prontuário de pacientes que foram submetidos anteriormente às cirurgias designadas, para identificar casos de delirium pós-operatório e elaborar este estudo descritivo. Resultados: Observamos uma incidência de 8,92% de delirium em sua maioria em pacientes do sexo feminino e com média de idade de 73 anos, portadores de hipertensão arterial. Conclusão: A incidência de delirium neste estudo assemelhou-se à observada na população geral em outros estudos da literatura. Não foi possível estabelecer uma correlação com distúrbios do sono, diabetes melito, ou tabagismo, apesar de a importância desses fatores para o acometimento de delirium já estar bem-estabelecida na literatura.

Humans , Male , Female , Adolescent , Adult , Aged , Aged, 80 and over , Young Adult , Postoperative Complications/epidemiology , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Knee/adverse effects , Delirium/etiology , Delirium/epidemiology , Postoperative Period , Brazil/epidemiology , Comorbidity , Sex Factors , Incidence , Retrospective Studies , Risk Factors , Age Factors , Sex Distribution , Age Distribution , Middle Aged
Rev. Asoc. Argent. Ortop. Traumatol ; 81(3): 199-205, set. 2016. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-842492


Introducción: Ante el difícil y cada vez más frecuente escenario de una revisión de cadera, existen diferentes alternativas para conseguir una fijación estable y duradera del componente femoral. El objetivo de este estudio fue evaluar la evolución clínica y radiográfica de los pacientes sometidos a una revisión del componente femoral con tallo cilíndrico de superficie rugosa extendida. Materiales y Métodos: Se llevó a cabo un estudio multicéntrico y retrospectivo de 148 pacientes, operados entre marzo de 1997 y marzo de 2010, a quienes se les realizó una cirugía de revisión femoral con un tallo cilíndrico con recubrimiento poroso. La edad promedio era de 63.1 años. Resultados: El seguimiento promedio fue de 7.7 años. En 134 (89,9%) pacientes, se observó una fijación ósea estable; en 12 (8%), una fijación fibrosa estable y, en 3 (2%), una fijación fibrosa inestable. El puntaje de Harris se modificó de 41 en el preoperatorio a 92 después de la cirugía. Las complicaciones fueron infección profunda (2 casos, 1,3%), fractura de fémur intraoperatoria (12,8%) y luxación protésica (3 casos, 2%). Conclusión: Los tallos cilíndricos con recubrimiento poroso han demostrado ser un eficaz recurso para solucionar la mayoría de las revisiones femorales por la posibilidad de obtener fijación estable a corto y largo plazo. Nivel de Evidencia: IV

Introduction: In the set of hip revision surgery there are different options to achieve a stable fixation of the femoral component. The objective of this study was to evaluate the clinical and radiographic outcomes of patients who underwent hip revision with cylindrical extensively porous stem. Methods: Between March 1997 and March 2010 a multicenter retrospective study was performed in 148 patients who underwent hip revision with cylindrical extensively porous stem. The mean age was 63.1 years. Results: The follow-up was 7.7 years. One hundred thirty-four (89.9%) patients achieved a stable bone ingrowth fixation; 12 (8%) a stable fibrous fixation and 3 (2%) a non-stable fixation. The Harris Hip Score improved from 41 points before surgery to 92 points in the postoperative period. Complications included: two deep infections (1.3%), 12 intra-operative femoral fractures (8%) and three hip dislocations (2%). Conclusion: The cylindrical extensively porous femoral stem seems to be a reliable technique for femoral hip revision surgery, as it is possible to obtain a short- and long-term stable fixation. Level of Evidence: IV

Middle Aged , Prosthesis Failure , Arthroplasty, Replacement, Hip/adverse effects , Femur/surgery , Hip Joint/surgery , Reoperation , Retrospective Studies , Follow-Up Studies , Treatment Outcome
Rev. Asoc. Argent. Ortop. Traumatol ; 81(3): 190-198, set. 2016. ilus, graf, tab
Article in Spanish | LILACS, BINACIS | ID: biblio-842491


Introducción: Se han logrado excelentes resultados con los tallos pulidos, cementados con tecnicas modernas, aun en pacientes jovenes, aunque su combinacion con superficie ceramica solo se ha comunicado en forma aislada. El objetivo de este estudio es analizar los resultados y las complicaciones de una serie de artroplastias de cadera con superficie ceramicaceramica, y tallos pulidos y conicos cementados con tecnicas de segunda y tercera generacion. Materiales y Métodos: Se evaluaron los resultados, las complicaciones relacionadas con el par de friccion y la supervivencia de 277 pacientes tratados con artroplastias de cadera con tallos pulidos y conicos cementados, en forma moderna, asociados a un par de friccion ceramica-ceramica. La edad promedio fue 56 anos; y el seguimiento minimo, de 6 anos. Resultados: No se detectaron aflojamientos radiologicos, migraciones, ni radiolucencias. La incidencia de infeccion fue del 1,3%. La incidencia de complicaciones por causas atribuibles a la cupla ceramica fue del 4%, y la de revision, del 1,4%. La supervivencia a siete anos, considerando revision por cualquier motivo fue del 95,8% (IC95% 94-99%), y considerando el aflojamiento aseptico, del 100%. Todos los casos de luxacion produjeron impregnacion metalica de la cabeza ceramica y esta fue la causa mas frecuente de revision. La incidencia de sonidos ha sido excepcionalmente baja comparada con las de otras series con fijacion no cementada. Conclusión: La asociacion de cementado moderno y tallos pulidos y conicos con superficies ceramicas ha demostrado ser una alternativa atractiva con una supervivencia a siete anos del 95%, sin aflojamientos asepticos. Nivel de Evidencia: IV

Introduction: Polished cemented stems with modern cementing techniques have shown excellent results even in young patients; nevertheless their results in combination with ceramic bearings are not known due to the lack of reports. We analyzed the results and complications of hip hybrid arthroplasties combining second- and third-generation cemented polished tapered stems and ceramic-ceramic bearings. Methods: Results, complications related to ceramic surfaces and survival rate of 277 patients treated with hip arthroplasties with polished stems cemented with modern techniques were evaluated. The mean age was 56 years and the minimum follow-up was 6 years. Results: No radiographic loosening, migration or radiolucencies were detected. The infection rate was 1.3%. The complication rate due to ceramic bearing was 4%, revision was required in 1.4%. Seven-year survival with revision for any reason as the endpoint was 95.8% (95%CI, 94-99%) whereas it reached 100% for aseptic loosening. Dislocation with metal impregnation was responsible of almost all revisions caused from complications related to bearing surfaces. The incidence of squeaking has been exceptionally low compared to other series with cementless fixation. Conclusion: The combination of modern cementing techniques of polished stems with ceramic on ceramic bearings has proven to be an attractive alternative with a 7-year survival of 95%, and no aseptic loosening. Level of Evidence: IV

Adult , Middle Aged , Postoperative Complications , Cementation/methods , Arthroplasty, Replacement, Hip/adverse effects , Hip Joint/surgery , Follow-Up Studies , Treatment Outcome
Acta ortop. mex ; 30(3): 116-118, may.-jun. 2016. tab, graf
Article in Spanish | LILACS | ID: biblio-837769


Resumen: Antecedentes: Los agentes etiológicos más frecuentes en las infecciones periprotésicas son Escherichia coli y Staphylococcus aureus. La frecuencia de estas infecciones se presenta en el reemplazo articular de rodilla de 0.68 a 1.60% en comparación con el de cadera de 0.67 a 2.4%. Objetivo: identificar cuáles son los agentes etiológicos más frecuentes en infecciones periprotésicas en adultos mayores y en pacientes con cirugía primaria de cadera y rodilla. Material y métodos: Se realizó un estudio observacional, transversal y retrospectivo, tipo serie de casos en un período comprendido de Junio de 2011 a Diciembre de 2014, se incluyeron pacientes mayores de 60 años con diagnóstico de infección periprotésica mediante dos cultivos positivos con antibiograma. Resultados: Se evaluaron 62 pacientes, 59.7% presentaron infecciones de rodilla y 40.3% de cadera, 59% fueron infecciones por Escherichia coli y 22% por Staphylococcus aureus. El antibiótico que mejor sensibilidad reportó fue trimetoprim-sulfametoxazol (40.3% )y el de mayor resistencia fue penicilina G (32.2%). Conclusión: Los agentes etiológicos más frecuentes fueron Escherichia coli y Staphylococcus aureus.

Abstract: Background: The most common etiological agents in periprosthetic infections are Escherichia coli and Staphylococcus aureus. The frequency of these infections are found in knee replacement with 0.68 to 1.60% compared to the hip with 0.67 to 2.4%. Objective: To identify what are the most common etiologic agents in periprosthetic infections in elderly patients with primary hip and knee surgery. Material and methods: An observational study, transverse and retrospective case series was performed in a period from June 2011 to December 2014, patients over 60 years with a diagnosis of periprosthetic infection by two positive cultures with antibiograma. Results: 62 patients were evaluated 59.7% were infections of knee and hip 40.3%, 59% were infections by Escherichia coli and Staphylococcus aureus 22%. The best sensitivity reported antibiotic trimethoprim-sulfamethoxazole was 40.3%. The largest penicillin G resistance 32.2%. Conclusion: The most common causative agents were Escherichia coli and Staphylococcus aureus.

Humans , Aged , Staphylococcal Infections/etiology , Prosthesis-Related Infections/microbiology , Arthroplasty, Replacement, Hip/adverse effects , Staphylococcus aureus/isolation & purification , Retrospective Studies , Arthroplasty, Replacement, Knee , Knee Prosthesis , Middle Aged , Anti-Bacterial Agents