Adecuación de la profilaxis antibiótica en la artroplastia de rodilla e infección del sitio quirúrgico: estudio de cohortes prospectivo / Antibiotic prophylaxis adequacy in knee arthroplasty and surgical wound infection: prospective cohort study

Objetivo. Evaluar el grado de adecuación al protocolo de profilaxis antibiótica en pacientes intervenidos de artroplastia de rodilla y su influencia en la infección quirúrgica. Material y método. Se realizó un estudio de cohortes prospectivo. El grado de adecuación se estudió mediante la comparación de las características de la profilaxis recibida por los pacientes y la estipulada en el protocolo vigente de nuestro hospital. El efecto de la profilaxis en la incidencia de la infección quirúrgica se estimó con el riesgo relativo. Resultados. Se incluyeron 1.749 intervenciones. La incidencia de infección del sitio quirúrgico fue del 1,43% (n=25). La adecuación global al protocolo de profilaxis antibiótica fue del 77,6%. La causa más frecuente de inadecuación al protocolo fue la duración prescrita de los antibióticos de la profilaxis (46,5%). La adecuación de la profilaxis antibiótica no influyó en la infección del sitio quirúrgico (RR=1,15; IC 95%: 0,31-2,99; p>0,05). Discusión. Los programas de vigilancia y control de la infección permiten evaluar factores de riesgo de infección y evaluar medidas de mejora. La vigilancia de las tasas de infección quirúrgica nos permite tomar las medidas oportunas encaminadas a reducir progresivamente su incidencia. Conclusiones. La adecuación de la profilaxis antibiótica fue alta, pero se puede mejorar. No hubo relación entre la adecuación de la profilaxis y la incidencia de infección de la herida quirúrgica en artroplastia de rodilla (AU)

Objective. Antibiotic prophylaxis is the most suitable tool for preventing surgical wound infection. This study evaluated adequacy of antibiotic prophylaxis in surgery for knee arthroplasty and its effect on surgical site infection. Material and method. Prospective cohort study. We assessed the degree of adequacy of antibiotic prophylaxis, the causes of non-adequacy, and the effect of non-adequacy on surgical site infection. Incidence of surgical site infection was studied after a maximum incubation period of a year. To assess the effect of prophylaxis non-adequacy on surgical site infection we used the relative risk adjusted with the aid of a logistic regression model. Results. The study covered a total of 1749 patients. Antibiotic prophylaxis was indicated in all patients and administered in 99.8% of cases, with an overall protocol adequacy of 77.6%. The principal cause of non-compliance was the duration of prescription of the antibiotics (46.5%). Cumulative incidence of surgical site infection was 1.43%. No relationship was found between prophylaxis adequacy and surgical infection (RR=1.15; 95% CI: .31-2.99) (P>.05). Discussion. Surveillance and infection control programs enable risk factors of infection and improvement measures to be assessed. Monitoring infection rates enables us to reduce their incidence. Conclusions. Adequacy of antibiotic prophylaxis was high but could be improved. We did not find a relationship between prophylaxis adequacy and surgical site infection rate (AU)

Antibiotic prophylaxis adequacy in knee arthroplasty and surgical wound infection: Prospective cohort study. / Adecuación de la profilaxis antibiótica en la artroplastia de rodilla e infección del sitio quirúrgico: estudio de cohortes prospectivo.

OBJECTIVE: Antibiotic prophylaxis is the most suitable tool for preventing surgical wound infection. This study evaluated adequacy of antibiotic prophylaxis in surgery for knee arthroplasty and its effect on surgical site infection. MATERIAL AND METHOD: Prospective cohort study. We assessed the degree of adequacy of antibiotic prophylaxis, the causes of non-adequacy, and the effect of non-adequacy on surgical site infection. Incidence of surgical site infection was studied after a maximum incubation period of a year. To assess the effect of prophylaxis non-adequacy on surgical site infection we used the relative risk adjusted with the aid of a logistic regression model. RESULTS: The study covered a total of 1749 patients. Antibiotic prophylaxis was indicated in all patients and administered in 99.8% of cases, with an overall protocol adequacy of 77.6%. The principal cause of non-compliance was the duration of prescription of the antibiotics (46.5%). Cumulative incidence of surgical site infection was 1.43%. No relationship was found between prophylaxis adequacy and surgical infection (RR=1.15; 95% CI: .31-2.99) (P>.05). DISCUSSION: Surveillance and infection control programs enable risk factors of infection and improvement measures to be assessed. Monitoring infection rates enables us to reduce their incidence. CONCLUSIONS: Adequacy of antibiotic prophylaxis was high but could be improved. We did not find a relationship between prophylaxis adequacy and surgical site infection rate.

Inestabilidad glenohumeral en pacientes mayores de 40 años: lesiones, tratamiento y complicaciones / Glenohumeral instability in patients over 40 years-old: Injuries, treatment and complications

Introducción. La inestabilidad glenohumeral recurrente es poco frecuente a partir de la cuarta década de la vida y presenta diferencias respecto de la del paciente más joven. Objetivo. Comparar las lesiones y las complicaciones postoperatorias de una población de 40 años o más intervenida de inestabilidad glenohumeral respecto a un grupo control más joven. Material y métodos. Se procedió a la revisión retrospectiva de los pacientes intervenidos mediante cirugía artroscópica de inestabilidad glenohumeral desde 1999 hasta 2011. Se realizó un seguimiento medio de 64 meses. El grupo principal estaba constituido por todos los pacientes de 40 años o más intervenidos en el periodo de estudio (n = 21), el cual fue comparado con un grupo control de pacientes más jóvenes seleccionado aleatoriamente con un tamaño similar (n = 27). Resultados. En el grupo de los mayores, la media de edad fue de 54 ± 11,86 años, mientras que en el grupo de menor edad fue de 26 ± 5,80 años. No se encontraron diferencias entre ambos grupos respecto a la presencia de lesión del labrum, lesión de Hill-Sachs y lesión de Bankart óseo (p > 0,05). La lesión del manguito de los rotadores fue 7,3 veces (IC del 95%, 2,5-21,6) más frecuente en el grupo de mayor edad (81%) respecto los de menor edad (p < 0,05). En cambio, las complicaciones neurológicas posteriores a la luxación no fueron más frecuentes en dicho grupo (p > 0,05). No se encontró asociación entre las complicaciones postoperatorias y la edad agrupada según el diseño (p > 0,05). Conclusiones. La inestabilidad glenohumeral anteroinferior recurrente después de la cuarta década de la vida presenta con frecuencia lesión del manguito de los rotadores. El tratamiento artroscópico de la inestabilidad fue eficaz, sin presentar mayores complicaciones postoperatorias (AU)

Introduction. Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. Objective. To compare injuries and complications after surgery between one group older than forty years of age and another younger group. Material and methods. A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n = 21), which was compared with a similar sized control group of randomly selected younger patients (n = 27). Results. The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group. There was no significant difference between the complications after surgery and the age according to the design (P>.05). Conclusions. Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications (AU)

[Glenohumeral instability in patients over 40 years-old: injuries, treatment and complications]. / Inestabilidad glenohumeral en pacientes mayores de 40 años: lesiones, tratamiento y complicaciones.

INTRODUCTION: Recurrent shoulder dislocation is infrequent after forty years and presents different injuries than younger patients. OBJECTIVE: To compare injuries and complications after surgery between one group older than forty years of age and another younger group. MATERIAL AND METHODS: A review was made o all patients who had undergone arthroscopic surgery due to glenohumeral instability from 1999 until 2011. The mean follow-up was 64 months. The case group consisted of all patients older than 40 years at the time of the surgery (n=21), which was compared with a similar sized control group of randomly selected younger patients (n=27). RESULTS: The mean age in the older group was 54 years (SD 11.86), while it was 26 years (SD 5.80) in the younger group. No differences were founded between both groups in labrum injury, Hill-Sachs injury, and bone Bankart lesion (P>.05). Rotator cuff tears were 7.3 times (95% CI; 2.5-21.6) more frequent in the older group (81%) compared to the younger group (P<.05). However, neurological injuries after dislocation were not more frequent in this group. There was no significant difference between the complications after surgery and the age according to the design (P>.05). CONCLUSIONS: Anterior recurrent dislocation after forty years of age is usually associated with rotator cuff tears. Arthroscopic treatment of instability was effective with no more postoperative complications.

Lesiones vasculares asociadas a luxación de rodilla: protocolo diagnóstico / Vascular injuries associated with dislocation of the knee: diagnosis protocol

Introducción. La luxación de rodilla es una entidad infrecuente. Puede tener consecuencias devastadoras, no solo por las lesiones ligamentosas, sino también por las complicaciones vasculares y nerviosas. Objetivo. Analizar la eficacia de un protocolo para el diagnóstico precoz de lesiones vasculares asociadas a las luxaciones de rodilla. Material y métodos. Se presenta un estudio retrospectivo de las luxaciones de rodilla agudas tratadas entre 1999-2010 con un seguimiento mínimo de 12 meses. Se utilizó un protocolo diagnóstico basado en la exploración física y el índice tobillo-brazo como pruebas de cribado inicial de lesión vascular. Resultados. Se obtuvo una muestra de 10 luxaciones, de las que en un 30% se produjo lesión de la arteria poplítea que fueron diagnosticadas precozmente, recibiendo tratamiento quirúrgico urgente antes de 8 horas. Dos pacientes tuvieron lesiones nerviosas asociadas a la vascular. Ningún caso acabó en amputación. Conclusiones. La utilización sistemática del protocolo ha evitado consecuencias derivadas de un diagnóstico tardío y ha reducido drásticamente el uso abusivo de pruebas invasivas como la arteriografía (AU)

Introduction. Knee dislocation is an unusual condition, and can have catastrophic consequences, such as vascular and neurological complications, in addition to the ligament injuries. Objective. The aim of this study is to analyse the effectiveness of a protocol of early diagnosis of vascular injuries associated with knee dislocations. Materials and methods. A retrospective study was conducted which included acute knee dislocations treated in our institution, with a minimum of 12 months follow-up, between 1999-2010. A diagnostic protocol based on physical examination and ankle-brachial index was used in order to detect vascular injuries. Results. Ten dislocations, 30% with popliteal artery injury, were diagnosed early and received emergency treatment within 8hours. There were associated neurological injuries in two patients. There were no amputations. Conclusions. The systematic use of this protocol has avoided consequences of late diagnosis and has drastically reduced the abusive use of invasive tests, such as arteriography (AU)

[Vascular injuries associated with dislocation of the knee: diagnosis protocol]. / Lesiones vasculares asociadas a luxación de rodilla: protocolo diagnóstico.

INTRODUCTION: Knee dislocation is an unusual condition, and can have catastrophic consequences, such as vascular and neurological complications, in addition to the ligament injuries. OBJECTIVE: The aim of this study is to analyse the effectiveness of a protocol of early diagnosis of vascular injuries associated with knee dislocations. MATERIALS AND METHODS: A retrospective study was conducted which included acute knee dislocations treated in our institution, with a minimum of 12 months follow-up, between 1999-2010. A diagnostic protocol based on physical examination and ankle-brachial index was used in order to detect vascular injuries. RESULTS: Ten dislocations, 30% with popliteal artery injury, were diagnosed early and received emergency treatment within 8 hours. There were associated neurological injuries in two patients. There were no amputations. CONCLUSIONS: The systematic use of this protocol has avoided consequences of late diagnosis and has drastically reduced the abusive use of invasive tests, such as arteriography.