scholarly journals Infección protésica de cadera. Recambio en dos tiempos en una serie de 50 casos.

2020 ◽  
pp. 99-107
Author(s):  
C SÁNCHEZ-LOSILLA ◽  
J DIRANZO-GARCÍA ◽  
V ESTREMS-DÍAZ ◽  
F JARA-GARCÍA ◽  
Antonio BRU-POMER ◽  
...  
Keyword(s):  
Chronic Infection ◽  
Hip Prosthesis ◽  
Functional Results ◽  
Implant Survival ◽  
Cure Rate ◽  
Two Stage ◽  
Revision Procedure ◽  
Hip Infection ◽  
Component Loosening

Chronic infection in hip replacement is an important complication with a complex treatment, that is solved by adequate antibiotic therapy together with single-stage exchange or two-stage exchange. We present a descriptive and retrospective study of a series of 50 consecutive patients operated on in our center with a diagnosis of chronic infection of the hip prosthesis between 2007 and 2018 with a two-stage exchange. At a mean follow-up of 52 months, the overall implant survival was 89%, with a 91% infection cure rate. The most frequent microorganism isolated was Staphylococcus epidermidis. The mean score achieved on the HHS was 82,4 points and 1.67 points on the visual analogue scale. We obtained better functional results (p=0,021) in those patients who had a preformed antibiotic-loaded spacer in the first surgical stage. As complications, we recorded four cases of prosthetic reinfection (8,7%), three cases of dislocation (6,5%), and one case of postsurgical hematoma (4,6%). No case of neurovascular injury or component loosening was recorded. According to the showed results, we consider that two-stage revision procedure, although it is a demanding surgery, is an effective method for the treatment of periprosthetic hip infection, with high implant survival and erradication of the infection.

scholarly journals Long-Term Results of Universal 2 Total Wrist Arthroplasty

2019 ◽  
Vol 08 (04) ◽  
pp. 317-320 ◽  
Author(s):  
H. J. A. Zijlker ◽  
M. J. P. F. Ritt ◽  
C. B. IJsselstein
Keyword(s):  
Patient Satisfaction ◽  
Long Term Results ◽  
Fourth Generation ◽  
X Rays ◽  
Implant Survival ◽  
Total Wrist Arthroplasty ◽  
Component Loosening

Background The Universal 2 is a widely used total wrist implant that aims to maintain function of the wrist. Purpose Promising mid-term results of the Universal 2 total wrist implant are described in the literature. This study evaluates the long-term results in terms of implant survival and patient satisfaction. Patients and Methods Patients who received a Universal 2 implant between 2004 and 2009 were retrospectively identified through a database search. Clinical outcome and complications of the implant were assessed by examination of the patient's medical records, X-rays, and a questionnaire, consisting of the Patient-Rated Wrist and Hand Evaluation questionnaire (PRWHE) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) questionnaires and additional questions. Results Twenty-five patients (26 wrists) were included in this study. Twenty-one (81%) Universal 2 implants remained in situ after a mean follow-up of 11 years. Moderate PRWHE (44) and QuickDASH (41) scores were found in these cases. Five Universal 2 implants failed and were converted to a total wrist arthrodesis after a mean period of 9.2 years due to distal component loosening (n = 3), recurrent luxation (n = 1), or recurrent synovitis (n = 1). Twenty-three (92%) patients were (very) satisfied with the Universal 2 implant. Conclusion The Universal 2 demonstrates a high (81%) implant survival with a high patient satisfaction after a mean follow-up of 11 years. Prospective studies of the Universal 2 implant are necessary to objectify improvement in wrist function and to provide a better comparison to other fourth generation wrist implants.

scholarly journals Mid- to Long-Term Results of Total Ankle Replacement in Patients with Hemophilic Arthropathy

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Franziska Eckers ◽  
Andreas Hingsammer ◽  
Reto Sutter ◽  
Stephan Wirth ◽  
Brigitte Brand-Staufer ◽  
...  
Keyword(s):  
Total Ankle Replacement ◽  
Long Term Results ◽  
Implant Survival ◽  
Hemophilic Arthropathy ◽  
Ankle Replacement ◽  
Sf 36 ◽  
The Mean ◽  
Component Loosening

Category: Ankle Arthritis Introduction/Purpose: Hemophilia is a rare hematological disease associated with spontaneous joint hemorrhaging causing hemophilic arthropathy. Symptoms comprise joint pain and deformity, paired with loss of function. In the presence of advanced joint deterioration, therapeutic options are confined to either arthroplasty or arthrodesis. For the ankle, the latter is still referred to as the procedure of choice. However - in light of its capacity to reduce pain while preserving ankle motion - total ankle replacement (TAR) has recently gained acceptance as an alternative. The aim of this study was to investigate the mid- to long-term results of TAR in hemophilic ankle arthropathy. Methods: Seventeen TARs were implanted between 1998 and 2012 (mean age: 43 years). Preoperative demographic and disease specific data, complications and revision surgeries were recorded. With a mean follow-up of 9.3 years (range, 2.2-17.8) implant survival was estimated using Kaplan-Meier analysis. Follow-up assessment of 12 TARs was performed after 9.6 years (5 lost to follow-up). Satisfaction and pain scales, the AOFAS hindfoot-score, and the SF-36 were obtained to assess clinical outcome. Radiographic evaluation of pre- and follow-up radiographs was conducted. Results: Three cases (17.6%) had undergone TAR removal secondary to loosening at an average interval of 7.5 years. The estimated implant survival was 94% at 5, 85% at 10, and 70% at 15 years (95% CI, 11.9-17.7). The mean estimated implant survival was 14.77 years (95% CI, 11.9-17.7). The mean level of satisfaction was 76%, and of pain 2/10 (VAS). ROM had increased significantly (p=0.037). The SF-36 summary scores were comparable to those of a matched standard population. The AOFAS hindfoot-score averaged 81/100 points. Conclusion: TAR is a viable treatment option for advanced hemophilic ankle arthropathy. Based on the herein presented follow- up, implant survival compares to that of non-hemophilic populations. Clinical mid- to long-term results are favorable. However, the majority of follow-up radiographs revealed component loosening and/or periprosthetic lucency. Considering the study population’s young age and specific risk factors, need for revision surgery secondary to symptomatic component loosening may arise.

Review of complications, functional outcome, and long-term survival following conversion of hip fusion to total hip arthroplasty

2021 ◽  
Vol 103-B (7 Supple B) ◽  
pp. 129-134
Author(s):  
Charles I. Ayekoloye ◽  
Moayad Abu Qa'oud ◽  
Mehran Radi ◽  
Sebastian A. Leon ◽  
Paul Kuzyk ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Total Hip Arthroplasty ◽  
Hip Arthroplasty ◽  
Functional Results ◽  
Implant Survival ◽  
Term Survival ◽  
Hip Fusion ◽  
Walking Aid

Aims Improvements in functional results and long-term survival are variable following conversion of hip fusion to total hip arthroplasty (THA) and complications are high. The aim of the study was to analyze the clinical and functional results in patients who underwent conversion of hip fusion to THA using a consistent technique and uncemented implants. Methods A total of 39 hip fusion conversions to THA were undertaken in 38 patients by a single surgeon employing a consistent surgical technique and uncemented implants. Parameters assessed included Harris Hip Score (HHS) for function, range of motion (ROM), leg length discrepancy (LLD), satisfaction, and use of walking aid. Radiographs were reviewed for loosening, subsidence, and heterotopic ossification (HO). Postoperative complications and implant survival were assessed. Results At mean 12.2 years (2 to 24) follow-up, HHS improved from mean 34.2 (20.8 to 60.5) to 75 (53.6 to 94.0; p < 0.001). Mean postoperative ROM was flexion 77° (50° to 95°), abduction 30° (10° to 40°), adduction 20° (5° to 25°), internal rotation 18° (2° to 30°), and external rotation 17° (5° to 30°). LLD improved from mean -3.36 cm (0 to 8) to postoperative mean -1.14 cm (0 to 4; p < 0.001). Postoperatively, 26 patients (68.4%) required the use of a walking aid. Complications included one (2.5%) dislocation, two (5.1%) partial sciatic nerve injuries, one (2.5%) deep periprosthetic joint infection, two instances of (5.1%) acetabular component aseptic loosening, two (5.1%) periprosthetic fractures, and ten instances of HO (40%), of which three (7.7%) were functionally limiting and required excision. Kaplan-Meier Survival was 97.1% (95% confidence interval (CI) 91.4% to 100%) at ten years and 88.2% (95% CI 70.96 to 100) at 15 years with implant revision for aseptic loosening as endpoint and 81.7% (95% CI 70.9% to 98.0%) at ten years and 74.2% (95% CI 55.6 to 92.8) at 15 years follow-up with implant revision for all cause failure as endpoint. Conclusion The use of an optimal and consistent surgical technique and cementless implants can result in significant functional improvement, low complication rates, long-term implant survival, and high patient satisfaction following conversion of hip fusion to THA. The possibility of requiring a walking aid should be discussed with the patient before surgery. Cite this article: Bone Joint J 2021;103-B(7 Supple B):129–134.

scholarly journals A Clinical Case of Two-Stage Visual-Functional Rehabilitation of a Patient with Postinfectious Central Corneal Opacity in Combination with Mixed Astigmatism Using Laser Keratorefractive Surgery

2021 ◽  
Vol 18 (4) ◽  
pp. 981-987
Author(s):  
N. V. Maychuk ◽  
I. A. Mushkova ◽  
M. R. Obraztsova
Keyword(s):  
Clinical Case ◽  
Treatment Algorithm ◽  
Visual Fields ◽  
Anterior Segment ◽  
Functional Results ◽  
Corneal Opacity ◽  
Film Rupture ◽  
Two Stage ◽  
Functional Rehabilitation

Introduction: to evaluate the clinical and functional results of two-stage treatment in a patient with post-infectious Central corneal opacity combined with mixed astigmatism.Patient and methods. Patient N., 19 years old with postinfectious (postherpetic) Central corneal opacity, mixed astigmatism was examined and operated using two-stage corneal laser treatment. To determine the possibility of surgical treatment of the patient, a complex of General ophthalmology was performed (checking visual acuity near and far in natural conditions and in conditions of drug-induced mydriasis, IOP measurement, autorefractometry, examination of visual fields, A- and Bscanning, ophthalmoscopy with examination of the Central and peripheral areas of the fundus), as well as special (keratopography and Scheimpflug camera examination, optical coherence tomography (OCT) of the anterior segment of the eye with analysis of the epithelial map, quantitative assessment (Schirmer test-1) and qualitative (tear film rupture time) lachrymal products, assessment of the epithelium state when stained with vital dyes and infrared meibography) research methods. To determine the activity of herpetic infection, PCR diagnostics were performed. The follow-up period was 2 years.Results and discussion. To achieve high visual-functional rehabilitation while preserving the native lens, a two-stage treatment algorithm was developed using technologies of laser corneal refractive surgery. At the first stage, in order to regularize the ocular surface and eliminate Central corneal opacity, an inverted topographically oriented PRK was performed; at the second stage, residual refractive errors were corrected using topographically oriented FemtoLASIK technology.Conclusion. According to the results of a literature search and analysis of Internet resources, there were no previously recorded and published works using a similar two-stage method. Therefore, the described clinical case justifies the relevance and novelty of the goal and has an evidence-based Foundation for the use of a two-stage laser keratorefractive treatment system in the ophthalmological practice of visual and functional rehabilitation of patients with Central corneal opacity in combination with mixed astigmatism or hypermetropic refraction. The two-year postoperative follow-up period showed stable and high visual-functional results with no recurrence of the inflammatory process.

The use of a non-invasive extendable prosthesis at the time of revision arthroplasty

2018 ◽  
Vol 100-B (3) ◽  
pp. 370-377 ◽  
Author(s):  
M. M. Gilg ◽  
C. L. Gaston ◽  
L. Jeys ◽  
A. Abudu ◽  
R. M. Tillman ◽  
...  
Keyword(s):  
Revision Arthroplasty ◽  
Leg Length Discrepancy ◽  
Implant Survival ◽  
Leg Length ◽  
Revision Procedure ◽  
Length Discrepancy ◽  
Prosthesis Revision ◽  
The Mean ◽  
Primary Bone Tumours

Aims The use of a noninvasive growing endoprosthesis in the management of primary bone tumours in children is well established. However, the efficacy of such a prosthesis in those requiring a revision procedure has yet to be established. The aim of this series was to present our results using extendable prostheses for the revision of previous endoprostheses. Patients and Methods All patients who had a noninvasive growing endoprosthesis inserted at the time of a revision procedure were identified from our database. A total of 21 patients (seven female patients, 14 male) with a mean age of 20.4 years (10 to 41) at the time of revision were included. The indications for revision were mechanical failure, trauma or infection with a residual leg-length discrepancy. The mean follow-up was 70 months (17 to 128). The mean shortening prior to revision was 44 mm (10 to 100). Lengthening was performed in all but one patient with a mean lengthening of 51 mm (5 to 140). Results The mean residual leg length discrepancy at final follow-up of 15 mm (1 to 35). Two patients developed a deep periprosthetic infection, of whom one required amputation to eradicate the infection; the other required two-stage revision. Implant survival according to Henderson criteria was 86% at two years and 72% at five years. When considering revision for any cause (including revision of the growing prosthesis to a non-growing prosthesis), revision-free implant survival was 75% at two years, but reduced to 55% at five years. Conclusion Our experience indicates that revision surgery using a noninvasive growing endoprosthesis is a successful option for improving leg length discrepancy and should be considered in patients with significant leg-length discrepancy requiring a revision procedure. Cite this article: Bone Joint J 2018;100-B:370–7.

Single-Stage Revision for Periprosthetic Hip Infection Using Antibiotic Loaded Impaction Graft

2016 ◽  
Vol 26 (6) ◽  
pp. 573-579 ◽  
Author(s):  
Ayman M. Ebied ◽  
Adel I. Elseedy ◽  
Osama Gamal
Keyword(s):  
Periprosthetic Infection ◽  
Treatment Time ◽  
Hip Prosthesis ◽  
Single Stage ◽  
Specific Protocol ◽  
Hip Infection ◽  
Attractive Option ◽  
Group A ◽  
Cemented Cup

Background Staged revision for periprosthetic infection of the hip is an accepted and widely used technique by many surgeons. However, single-stage exchange of the hip prosthesis remains an attractive option to others because of the advantages of reduced morbidity, shorter treatment time and hospital stay in addition to the reduced cost of treatment. Hypothesis Single-stage revision for periprosthetic hip infection can achieve excellent results if a specific protocol for patients’ selection and management is followed. Methods 52 patients with evidence of periprosthetic infection had preoperative aspiration of the affected hip. The infecting organisms were identified in 33/52 and single-stage revision was performed. The remaining 19 patients had a 2-stage exchange arthroplasty. Patients in the single-stage revision protocol had antibiotic loaded morsellized bone graft, a cemented cup and a long cementless stem. Results At an average follow up of 6 (range 4-8) years postoperatively, only 1 case of persistent infection was found in the single-stage group – a 97% rate of eradicating infection was achieved. Discussion Single-stage exchange achieves excellent success rate in patients with periprosthetic infection when a specific protocol for patient selection and management is followed.

Polymicrobial infections reduce the cure rate in prosthetic joint infections: outcome analysis with two-stage exchange and follow-up ≥two years

2015 ◽  
Vol 40 (7) ◽  
pp. 1367-1373 ◽  
Author(s):  
Matthias D. Wimmer ◽  
Max J. Friedrich ◽  
Thomas M. Randau ◽  
Milena M. Ploeger ◽  
Jan Schmolders ◽  
...  
Keyword(s):  
Outcome Analysis ◽  
Cure Rate ◽  
Two Stage ◽  
Joint Infections ◽  
Prosthetic Joint ◽  
Prosthetic Joint Infections ◽  
Polymicrobial Infections

scholarly journals Reinfection and re-revision rates of 113 two-stage revisions in infected TKA

2020 ◽  
Vol 5 (3) ◽  
pp. 137-144 ◽  
Author(s):  
Joris Bongers ◽  
Anouk M.E. Jacobs ◽  
Katrijn Smulders ◽  
Gijs G. van ◽  
Jon H.M. Goosen
Keyword(s):  
Joint Infection ◽  
Two Stage ◽  
Reinfection Rate ◽  
Large Variability ◽  
Musculoskeletal Infection ◽  
Revision Procedure ◽  
Suspected Infection ◽  
Total Knee

Abstract. Introduction: Two-stage revision is the most frequently performed revision procedure of a (suspected) periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). The reported results of this treatment show large variability between studies, ranging between 0 - 40 percent failure. The purposes of this study were to determine long term (1) reinfection rate, (2) re-revision rates for any reason, and (3) the reinfection rate of patients with positive cultures at reimplantation.Methods: We prospectively followed and retrospectively reviewed 113 consecutive two-stage revision TKAs, performed between 2003 and 2013 in our clinic with a minimum follow-up of 2 years. Diagnosis of PJI was based on the major Musculoskeletal Infection Society criteria for PJI.Results: After a mean follow-up of 94 months (range 24-172 months), infection recurred in 23 cases (23%). Of these, nine cases (9%) were defined as relapse (same micro-organism as index revision) and in 14 cases another causative was found (14%). In 11 patients debridement, antibiotics and retention of the prosthesis successfully eradicated the reinfection. After overall follow-up 17 patients (17%) underwent re-revision surgery, 11 patients (11%) due to an infection and 6 patients (6%) for aseptic reasons.Conclusions: Treatment of a (suspected) infection of a TKA by a two-stage revision had acceptable results based on re-revision and re-infection rates in the long term (>5 years), resembling the short-term results (<2 years). Focussing on the cultures at the index two-stage revision, episodes of relapse and new infections during follow-up were almost equally divided. Reinfection rates were higher in cases with positive cultures at reimplantation. Patients should be counselled appropriately in this particular situation.

Sign in / Sign up

Export Citation Format

Share Document