Defensive antibacterial coating in revision total hip arthroplasty: new concept and early experience.

BACKGROUND: Infections remains the most feared complication in total hip arthroplasty (THA). New strategies of PJI prevention includes coating of conventional implants. Defensive Antibacterial Coating (DAC), an antibacterial hydrogel coating made of hyaluronan, poly-D and L-lactide can protect biomaterials as an effective barrier at the time of implantation. In addition, it can be used with topical antibiotics to prevent early colonisation of the implant. SCOPE: This manuscript describes the detailed function of the DAC in general as well as an analysis of its use in revision THA in a series of 28 patients in a short-term follow-up.Its use in patients undergoing cementless re-implantation after 2-staged procedures in THA is described in detail within the manuscript. CONCLUSION: DAC found to be effective in terms of infection control and safety in our patient cohort and has been expanded for cementless 1-staged revisions in PJI of the hip in our institution.

Complicações em artroscopia de quadril / Complications in hip arthroscopy

OBJETIVOS: Determinar a prevalência de complicações ocorridas em uma série de casos consecutivos de artroscopia de quadril; avaliar a evolução da casuística através de uma curva de aprendizado; reconhecer as causas das complicações nas cirurgias do quadril por via artroscópica. MÉTODOS: Foram avaliados 150 casos consecutivos submetidos à artroscopia de quadril no período de maio de 2004 a dezembro de 2008. As complicações encontradas foram classificadas sob três aspectos: sistema orgânico acometido, gravidade, grupos de 50 casos de acordo com a ordem de realização do procedimento. Utilizaram-se para a análise dos dados obtidos a estatística descritiva e o teste exato de Fisher. RESULTADOS: Observaram-se 15 complicações (10 por cento) neste estudo. Dez foram complicações neurológicas, duas osteoarticulares, uma vásculo-isquêmica e duas cutâneas. Na classificação de gravidade, três foram classificadas como maiores, 12 intermediárias e nenhuma considerada menor. A incidência das complicações ao longo da curva de aprendizado não apresentou diferença estatística significativa (p = 0,16). CONCLUSÕES:A artroscopia de quadril é um procedimento cirúrgico de baixa morbidade, que cursa, em alguns casos, com complicações. Essas são, frequentemente, neurológicas e transitórias. Elas ocorrem, principalmente, devido à tração articular. A taxa de complicações não diminuiu com o evoluir da casuística.

OBJECTIVES: to determine the prevalence of complications in a series of consecutive cases of hip arthroscopy; to assess the progression of the casuistic through a learning curve; and to recognize the causes of complications in arthroscopic hip surgeries. METHOD: 150 consecutive cases were evaluated, who were submitted to hip arthroscopy from May 2004 through December 2008. All the surgical complications described were classified according to three aspects: organic system involved, severity, and every 50 consecutive cases. The data obtained were analyzed, and statistical analysis was carried out using Fischer's exact test. RESULTS: We observed 15 complications (10 percent) in this study; two osteoarticular, one ischemic vascular and two cutaneous. In the classification of severity, 3 were classified as very severe, 12 as intermediary and none as not severe. The incidence of complications through our learning curve showed no statistical significance (p=0.16). CONCLUSIONS: Hip arthroscopy is a surgical procedure that involves low morbidity, but that still presents complications in some cases. These complications are frequently neurological and non-permanent, and are mainly due to the joint traction. The complication rate did not decrease with the progression of our casuistic.