Espaciadores estáticos de cemento con antibiótico en la infección protésica de rodilla: técnica de elaboración y movilidad posoperatoria / Static cement spacers in total knee infection: custom manufacturing technique and postoperative motion

Introducción: A pesar de las mejoras en la técnica quirúrgica en reemplazos totales de rodilla, el número de infecciones posquirúrgicas continúa en aumento. En la bibliografía mundial, está demostrado que las revisiones en dos tiempos logran mayores porcentajes de curación que las de un solo tiempo. El objetivo de este trabajo es mostrar nuestra técnica de elaboración de los espaciadores estáticos y los resultados obtenidos con estos espaciadores en revisiones de reemplazos totales de rodillas infectadas, tratadas en dos tiempos y, además, evaluar la movilidad obtenida. Materiales y Métodos: De 1997 y 2010, en nuestro Centro, se efectuaron 153 revisiones de reemplazos totales de rodilla, 33 (21 %) fueron a causa de una infección periprotésica crónica, tratada en dos tiempos, con el uso de un espaciador estático de cemento con antibiótico. La serie estaba conformada por 33 rodillas en 32 pacientes, con un promedio de edad de 69 años y un seguimiento de 3.5 años. Resultados: Treinta (91%) de las 33 rodillas se curaron. Veintiocho fueron reimplantadas exitosamente, 2 rodillas con infección curada no fueron reimplantadas por distintos motivos y permanecieron con el espaciador en forma definitiva y la infección persistió en 3 casos. Las 28 rodillas reimplantadas evolucionaron favorablemente, con una movilidad de 90° a los 3.15 meses de posoperatorio promedio. Conclusiones: Con el empleo de espaciadores estáticos de rodilla, obtuvimos un porcentaje de curación similar al publicado con espaciadores articulados. La ventaja de los primeros es su fácil fabricación y colocación, le otorgan a la articulación una adecuada estabilidad y un aceptable rango de movilidad posoperatoria.

Background: Despite improvements in surgical technique, the number of infections after total knee arthroplasty continues to rise. According to bibliographic reviews, the two-stage exchange procedure has obtained higher percentages of cure than that performed in a single stage. The purpose of this paper was to show our technique for preparing the static spacer, the results and the range of motion achieved with two-stage revision of infected total knee arthroplasty using those spacers. Methods: We performed 153 total knee arthroplasty revisions between 1997 and 2010, 33 (21%) of them due to a prosthetic chronic infection, treated with a two-stage procedure with cement static spacer with antibiotic. We evaluated 33 total knee arthroplasties in 32 patients, with an average age of 69 years and an average postoperative follow-up of 3.5 years. Results: Healing was achieved in 30 (91%) of the 33 knees. Twenty-eight knees were successfully reimplanted, two with healing infection were not reimplanted for different reasons and 3 had persistent infection. The 28 reimplanted knees evolved favorably, achieving a range of motion of 90º in an average of 3 months after surgery. Conclusions: The static knee spacer achieved a similar healing rate to that obtained with articulated spacers. The advantage of static spacers is its easy manufacture and placement, giving greater stability and an acceptable range of motion.

Treatment of Massive Defect in Achilles Tendon with Tendon Allograft: A Case Report / 대한족부족관절학회지

Deep infection of Achilles tendon is one of the serious complications that occur after open repair of the tendon. It sometimes leads to a very large tendon defect during the course of treatment. We report on a case of massive defect in Achilles tendon, which was successfully treated with Achilles tendon allograft and flexor hallucis longus tendon transfer.

Achromobacter xylosoxidans Infection Following Total Knee Arthroplasty / 대한정형외과학회잡지

Achromobacter xylosoxidans is an opportunistic organism, mainly causing infection in immune compromised hosts, such as patients on dialysis. However, review of the medical literature showed that few cases of A. xylosoxidans infections following total knee arthroplasty have been reported. This organism has not been reported in prosthetic joint infections of patients who are not immune compromised. Here, a case of periprosthetic infection with A. xylosoxidans following total knee arthroplasty in a man with no medical history of immune suppression is reported.

Consideraciones actuales sobre las infecciones posoperatorias / Current considerations on the postoperative infections

A pesar de los avances de las técnicas quirúrgicas, anestésicas, microbiológicas, así como de la ingeniería genética y la biotecnología, las infecciones constituyen el enemigo invisible del paciente operado. La aparición de infección nosocomial en el periodo posoperatorio constituye una complicación frecuente que, independientemente de todas las medidas de prevención y control, aumenta la morbilidad y mortalidad posquirúrgicas; pues, además de comprometer los resultados de las intervenciones, favorecen la aparición de otras complicaciones, en ocasiones fatales, con repercusiones socioeconómicas muy desfavorables para el enfermo y las instituciones sanitarias. Por esas razones, la revisión sobre este tema nunca pierde actualidad, dado su origen multifactorial, diversidad de localizaciones y variedad de gérmenes que las provocan. Así, este artículo pretende contribuir a su prevención, diagnóstico precoz, tratamiento oportuno y adecuado, según las buenas prácticas médicas y quirúrgicas.

In spite of the advances of the surgical, anesthetic and microbiologic techniques, as well as of the genetic engineering and the biotechnology, infections constitute the invisible enemy of the operated patient. The occurrence of nosocomial infection in the postoperative period constitutes a frequent complication which, independently from all the prevention and control measures, increases the postsurgical morbidity and mortality, as besides compromising the results of the interventions, they favor the appearance of other complications, occasionally fatal, with very unfavorable socioeconomic repercussions for the sick person and the health institutions. For these reasons, the review on this topic never loses updating, given its multifactor origin, diversity of localizations and variety of germs provoking them. Thus, this work seeks to contribute to its prevention, early diagnosis, opportune and appropriate treatment, according to the good medical and surgical practices.

Relations between Long-term Glycemic Control and Postoperative Wound and Infectious Complications after Total Knee Arthroplasty in Type 2 Diabetics

BACKGROUND: The authors examined whether poor preoperative glucose control, as indicated by the hemoglobin A1c (HbA1c) level of more than 8%, is associated with postoperative wound and infectious complications in diabetic patients that have undergone total knee arthroplasty (TKA). METHODS: One hundred and sixty-seven TKAs performed in 115 patients with type 2 diabetes mellitus, from January 2001 through March 2007, were retrospectively reviewed. Logistic regression was used to identify the variables that had a significant effect on the risk of wound complications or early deep infection. The variables considered were age, gender, body mass index, comorbidities, operation time, antibiotic-impregnated cement use, amount of blood transfusion, close suction drain use, duration of diabetes, method of diabetes treatment, diabetes complications, and preoperative HbA1c level. RESULTS: The overall incidence of wound complications was 6.6% (n = 11) and there were seven cases (4.2%) of early postoperative deep infection. Logistic regression revealed that the independent risk factors of wound complications were preoperative HbA1C > or = 8% (odds ratio [OR], 6.07; 95% confidence interval [CI], 1.12 to 33.0) and operation time (OR, 1.01; 95% CI, 1.00 to 1.03). No variable examined was found to be significantly associated with the risk of early postoperative deep infection. CONCLUSIONS: Poorly controlled hyperglycemia before surgery may increase the incidence of wound complications among diabetic patients after TKA.

Preoperative Risk Factors for Deep Infection Following Total Knee Replacements

PURPOSE: The aim of this study was to investigate the overall rate of deep infection and the risk factors for infection after primary total knee arhroplasties. MATERIALS AND METHODS: We conducted a retrospective case-control study of 229 patients (376 knees) who underwent total knee replacement (TKR) between January 2006 and June 2007 and who were followed up for more than one year. The risk factors for deep infection were determined via univariate analyses. RESULTS: The overall rate for developing infection was 1.9% (7 of 376). The risk factors were an operating theatre other than the main room (odds ratio=33.2, 95% confidence interval=1.9, 583.6) and a preoperative hemoglobin level lower than 12 mg% (odds ratio=4.3, 95% confidence interval=1.9, 9.4). CONCLUSION: The deep infection rates after TKRs might vary depending on the preoperative level of hemoglobin and the operating-room environment. Successful strategies to overcome the host and environmental risk factors are needed with the goal of preventing infection of the prosthesis.

Risk Factors of Deep Infection after Thoracic and Lumbar Spinal Arthrodesis / 대한척추외과학회지

STUDY DESIGN: This is a retrospective analysis OBJECTIVES: We wanted to analyze the risk factors related to deep infection and removing an implant after thoracic and lumbar spinal arthrodesis. SUMMARY OF LITERATURE REVIEWS: The relationship between deep infection and implant removal is controversial. MATERIALS AND METHODS: We retrospectively compared the infection group with the non-infection group for the rates of deep infection, the preoperative diagnosis, the number of fused segments, the operative methods, the graft materials, the operating time and the blood loss. Moreover, we classified the deep infection patients into two groups: those who underwent implant removal and those who did not, and we compared the microorganisms that were cultured out of the patients. We also compared the relationship of deep infection with the risk factors, the mean hospital stay and the mean number of operations. RESULTS: There were 18 cases (2.46%) of deep infection. The factors that did not show a significant difference were the preoperative diagnosis, the graft material, the increased number of fused segments, age, gender and BMI. The factors that were significant were the operating time (p=0.001), the amount of blood loss (p<0.000), DM (p=0.021), and PLF (p=0.054). The incidence of implant removal was higher for the cases with deep infection caused by MRSA. We were able to see a significant difference of between the group that had undergone implant removal and the group that had not undergone implant removal. CONCLUSIONS: The incidence of deep infection after thoracic and lumbar spinal athrodesis increased as the operating time and blood loss increased, and it was also higher when either PLF or DM were present. Implant removal causes bad clinical results, so physicians should be very cautious when operating on a case of implant removal.

Arthroscopic Treatment of Acutely Infected Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: This study is to evaluate the results of arthroscopic treatment for an acutely infected total knee arthroplasty (TKA) and to determine the protocol for a successful arthroscopic treatment. MATERIALS AND METHODS: Of 16 cases of acutely infected TKA treated at this institution, 7 cases treated with arthroscopic debridement were retrospectively reviewed. The indication for arthroscopic debridement was patients with a radiographically stable prosthesis and within 72 hours of the onset of symptoms. The necessity and method of the secondary procedures were determined using a follow up of the C-reactve protein (CRP) test and physical examination after the primary arthroscopic debridment. Successful treatment was defined as no recurrence or no re-operation by the final follow-up. RESULTS: All 7 cases were treated with a retention of the prosthesis. 3 cases were treated successfully with primary arthroscopic debridement only. Three cases were treated with open debridement after primary arthroscopic debridement. One case was treated with repeated arthroscopic debridement after primary arthroscopic debridement. CONCLUSION: Arthroscopic debridement is an effective treatment option for an acutely infected TKA within 72 hours of the onset of symptoms. A careful CRP follow up is suggested as the critical index to determine the secondary procedure for successful treatment of an acutely infected TKA by arthroscopic debridement.

Results of Treatment for Acute Deep Infected Total Knee Arthroplasty / 대한정형외과학회잡지

PURPOSE: To evaluate the results of open or arthroscopic debridememt with a retention of the components for acute deep infected total knee arthroplasty. MATERIALS AND METHODS: From January 1991 to December 2005, among 1282 patients, 1457 TKAs, 8 cases of acute deep infected total knee arthroplasty was retrospectively reviewd. A radiologic and clinical assessment were performed to analyze the treatment results. The mean age was 63.9 (57-77) years. One patient was male, and 7 were female. RESULTS: The acute infection rate was 0.55% and the mean follow-up period was 41 months ( range, 30 months to 62 months). Using the Segawa classification, 3 cases were Type 2, and five cases were Type 3. Six cases were treated with arthroscopic debridement and antibiotic therapy. Two cases were treated with open debridement and antibiotic therapy. Intravenous antibiotic therapy was administered over a 3 week period. There were 2 cases of recurred infection. In synovial fluid culture, 4 cases were positive to S. aureus, 2 cases were positive to S. epidermidis and no bacteria was found in 2 cases. At the last follow-up, the mean Knee Society Score was 86.4 points. There were no chronic infection, loosening or osteolytic changes in the implants. CONCLUSION: If an early diagnosis is made, open or arthroscopic debridememt with a retention of the components is a useful method for acute deep infected total knee arthroplasty.

Deep Infection following Instrumented Posterior Fusion / 대한정형외과학회잡지

PURPOSE: This study evaluated the diagnosis, treatment and related results for cases with a deep infection after instrumented posterior fusion. MATERIALS AND METHODS: Among the 306 cases of posterior instrumented spinal fusion, Seventeen cases who developed deep infection were reviewed retrospectively. RESULTS: The incidence of deep infections was 5.6% and the mean age of the cases with a deep infection was 55 years old. Nine out of 17 cases had the preoperative risk factors such as old age, diabetes, malnutrition, obesity, etc. The mean duration to diagnosis of a postoperative infection was 12.9 days (4-8 days). The clinical manifestations were fever, night pain and abscess drainage. In all cases, the value of the WBC, ESR and CRP were elevated. All cases were treated surgically as soon as possible with abscess drainage, debridement and the insertion of antibiotics-mixed cement beads without the removal of the instrument. The most common bacterial organisms were Coagulase negative Staphylococcus aureus in 11 cases. Vancomycin was used as the antibiotic. During the follow-up period, 2 cases were treated with the removal of the instruments due to metal failure and a delayed deep infection with loosening. The average follow-up was 32 months (12-56 months). 15 cases were controlled successfully without needing to remove the instruments and without complications. CONCLUSION: The meticulous care for a deep infection after posterior instrumented spinal fusion is essential. Favorable results can be achieved by surgery with drainage, debridement, and the insertion of antibiotics-mixed cement beads along with systemic antibiotics as soon as possible without removing the instruments.

Bacteriostasis Test in vitro of Deep Yeast-like Fungi by Radix Scutellariae,Radix Sophorae Flavescentis and Flos Lonicerae in Gansu / 中华医院感染学杂志

OBJECTIVE To find the active principle in Radix Scutellariae,Radix Sophorae Flavescentis and Flos Lonicerae in Gansu inhibiting yeast-like fungi of deep infection.METHODS Radix Scutellariae,Radix Sophorae Flavescentis and Flos Lonicerae were separately cleaned,toasted and grinded to fine power.Five kinds of(8 strains) yeast-like fungi that were collected and spread into 90mm Sabouraud plate.On aseptic condition,bored holes on Sabouraud plate with the drilling instrument of 6mm diameter,and filled every holes with 25.73mg fine powder of Radix Scutellariae,Radix Sophorae Flavescentis and Flos Lonicerae,and added 3 to 5 drops of distilled water in the medicinal powder.Under 35℃,the bacteria were cultured for 24 to 48 hours,and the size of bacteriostatic ring was observed.RESULTS The diameters of the bacteriostatic ring of Radix Scutellariae powder inhibiting five kinds of yeast-like fungi were separately 16.0mm,13.5mm,13.0mm,13.0mm and 10.5mm,respectively,and the diameter of Radix Sophorae Flavescentis and Flos Lonicerae powder was 0.CONCLUSIONS There is the active principle inhibiting yeast-like fungi in Radix Scutellariae,but not that in Radix Sophorae Flavescentis and Flos Lonicerae.

Treatment of Deep Infection Following Repair of Achilles Tendon Rupture / 대한족부족관절학회지

PURPOSE: Theaim of this study was to review the results of treatment for deep infection following repair of Achilles tendon rupture using reverse sural arterialized flap and/or flexor hallucis longus transfer. MATERIALS AND METHODS: Five cases of Achilles tendon infection in five patients were treated using reverse sural arterialized flap and/or flexor hallucis longus transfer at our hospital with followed up of average 23.6 months (range, 13-43 months). Three patients were male and average age at surgery was 52.0 years (range, 42-59 years). Clinical results were evaluated by the method of Percy and Conochie, and the isokinetic peak torque value was interpreted according to the guideline of Sapega. RESULTS: The clinical result was excellent in three cases, good in one case and fair in one case. The isometric peak torque value for 30 degrees per second was normal in two cases, possibly abnormal in one case, and probably abnormal in two cases, and for 120 degrees, normal in one case, probably abnormal in four cases. Five cases in five patients were satisfied with the result of treatment. CONCLUSION: We can expect satisfactory results of treatment for deep infection following repair of Achilles tendon rupture using reverse sural arterialized flap and/or flexor hallucis longus transfer.

Experience of Revision Operation for Infected Total Knee Arthroplasty

PURPOSE: The purpose was to report the results of revision by two or more than three times operation using antibiotics impregnated cement block for the treatment of deep infection after total knee arthroplasty. MATERIALS AND METHODS: Between June 1999 and October 2001, 6 patients were reviewed retrospectively, who were treated for deep infection after total knee arthroplasty. At the time of reimplantation, the average age was 67 years. The average follow-up period was 26.7 months. Two coagulase-negative Staphylococcus aureus infections and one methicillin resistant Staphylococcus aureus infection were found on culture study. In three cases, group I, antibiotics impregnated cement block was inserted at the first operation. And then reimplantation was performed at 2nd operation as two-stage reimplantation. In another three cases, group II, debridement was done without removal of implant at the first operation. All three cases were failed to control infection. The infection was controlled and reimplantation was done at 4th time operation. The results were assessed according to the knee rating system of the Hospital for Special Surgery (HSS). Recurrence of infection or development of any other complication was evaluated. RESULTS: The average range of knee motion was 88 degrees at the time of diagnosis of deep infection, and it was 92 degrees at final follow-up. The average range of motion was 107 degrees in group I and 77 degrees in group II. Functional knee score of the HSS was improved from 69 points preoperatively to 88 points postoperatively. Each mean HSS score was 93 points in group I and 81 point in group II. There were no recurrence of infection during follow-up period after reimplantation. CONCLUSION: When the diagnosis of deep infection is confirmed in total knee arthroplasty, removal of the implants, thorough debridement and insertion of antibiotics impregnated bone cement blocks at the first operation is apparently better than only debridement without removal of implant. And two-stage reimplantation is better results in preserving knee joint function.

Management of Deep Infection after Posterior Spinal Instrumentation with Prolonged Suction Drainage / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis about related diagnostic and therapeutic factors in postoperative deep infection cases after posterior spinal instrumentation. OBJECTIVES: Analysis of the inherent risk factors associated with deep infection and the efficacy of management with prolonged suction drainage without removal of implants. SUMMARY OF LITERATURE REVIEW: Various treatment modalities have been applied to control deep infection after spinal instrumentation. Validity of removing implants to control the infection is still controversial because it may cause loss of spinal stability. MATERIALS AND METHODS: Five cases of postoperative deep infection after posterior spinal fixation from May 1996 to May 2000 were investigated about combined general illness, features of infection, various profiles on management of the infection with surgical irrigation and debridement followed by prolonged suction drainage, and final outcomes. RESULTS: Remarkable risk factors were diabetes and obesity. Evidences of infection such as discharge from the wound, dehiscence, fever were observed since average 18.8th day postoperatively. By only one surgical procedure for each patient followed by prolonged suction drainage for mean 19.2 days and administration of IV antibiotics for average 43.6 days followed by oral antibiotics for 33.8 days, deep infections were controlled successfully without removal of implants and without any grave complications. All achieved favorable clinical results and posterolateral fusion. CONCLUSION: Irrigation and debridement accompanied by prolonged suction drainage using Hemo-vac and administration of susceptible antibiotics seemed to be one of the effective methods in controlling deep infection after posterior instrumentation and in maintaining the postoperative stability of spine.

A Clinical Study of Deep Infection after Cementless Total Hip Arthroplasty / 대한정형외과학회잡지

Deep infection following total hip replacement arthroplasties remains one of the most serious complications in orthopaedic surgery. Between Jan. 1986 to Dec. 1991, 1130 cementless total hip arthroplasties were performed at Wilson rehabilitation hospital. Among them, fourteen patients (incidence :1.2%) developed deep wound infection, and they were retrospectively reviewed including clinical features, laboratory datas and their managements. The infection was noted in ten patients within three months, in one patient between three to twelve months and in three patients after twelve months from cementless total hip replacement arthroplasties. All of them were suffered from hip pain, six patients were manifested with generalized fever, and twelve patients with draining fistulas. Thirteen patients showed elevated ESR. Major infecting organism was Staphylococcus in ten patients. They were initially treated with meticulous debridement, ingress and eress tube irrigation, and antibiotics, but four patients had to be operated Girdlestone arthroplasties due to recurrence of infection and loosening of the prosthesis. Eight patients got quiescency from infection for at least five months from the last drainage operation. But two patients still have draining fistulas inspite of bony ingrowth achieved to the prosthesis.

Report of salvage Procedures in Failed Total Hip Replacement / 대한정형외과학회잡지

No abstract available in English.