Primerjava kliničnega izida vstavitve totalne endoproteze kolka preko anteriornega in lateralnega pristopa: sistematični pregled z metaanalizo

Izhodišča: Totalna endoproteza kolka velja za enega najuspešnejših posegov v ortopedski kirurgiji. Pomemben dejavnik vpliva na izid je izbira kirurškega pristopa. Trenutno je v svetu najbolj razširjen stranski pristop, v zadnjem času pa postaja zaradi manj poškodb mehkih tkiv vse bolj priljubljen sprednji pristop. Metode: V sistemski pregled smo vključili randomizirane kontrolirane raziskave iz podatkovnih baz PubMed in Cochrane Library ter raziskave, prijavljene pri Clinical Trials. Iskanje smo opravili decembra 2019. Zabeležili smo podatek o državi, velikosti vzorca, posegu, izidu in času spremljanja. Metaanalizo smo opravili s programom Review Manager 5.3. Rezultati: V metaanalizo smo vključili 7 randomiziranih kontroliranih raziskav s 723 preiskovanci. Med sprednjim in stranskim pristopom totalne endoproteze kolka ni razlik v funkcionalnem stanju, vrednotenem po Harrisu ob koncu spremljanja, v oceni bolečine po vizualni analogni lestvici tako v zgodnjem kot poznem obdobju po operaciji, v izgubi krvi, v potrebi po transfuziji, v trajanju bolnišnične oskrbe in v pojavnosti zapletov med operacijo in po njej. Zaključki: Primerjava sprednjega in stranskega pristopa kaže, da med pristopoma ni statistično pomembnih razlik v funkcionalnem stanju ob koncu spremljanja, v oceni bolečine tako v zgodnjem kot poznem obdobju po operaciji, v izgubi krvi, v potrebi po transfuziji, v trajanju bolnišnične oskrbe in v pojavnosti zapletov med operacijo in po njej. Trenutno ne poteka nobena randomizirana kontrolirana raziskava, ki bi primerjala izid sprednjega in stranskega pristopa z natančno zastavljenim protokolom spremljanja

The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus

Eficacia; Tratamiento antibiótico; Infección articularEficàcia; Tractament antibiòtic; Infecció articularEfficacy; Antibiotic treatment; Joint infectionObjectives: Patients with prosthetic joint infections (PJIs) not suitable for curative surgery may benefit from suppressive antibiotic therapy (SAT). However, the usefulness of SAT in cases with a draining sinus has never been investigated. Methods: A multicentre, retrospective observational cohort study was performed in which patients with a PJI and a sinus tract were eligible for inclusion if managed conservatively and if sufficient follow-up data were available (i.e. at least 2 years). SAT was defined as a period of > 6 months of oral antibiotic therapy. Results: SAT was initiated in 63 of 72 (87.5 %) included patients. Implant retention during follow-up was the same in patients receiving SAT vs. no SAT (79.4 % vs. 88.9 %; p=0.68). In total, 27 % of patients using SAT experienced side effects. In addition, the occurrence of prosthetic loosening in initially fixed implants, the need for surgical debridement, or the occurrence of bacteremia during follow-up could not be fully prevented with the use of SAT, which still occurred in 42 %, 6.3 %, and 3.2 % of cases, respectively. However, the sinus tract tended to close more often (42 % vs. 13 %; p=0.14), and a higher resolution of pain was observed (35 % vs. 14 %; p=0.22) in patients receiving SAT. Conclusions: SAT is not able to fully prevent complications in patients with a draining sinus. However, it may be beneficial in a subset of patients, particularly in those with pain or the hindrance of a draining sinus. A future prospective study, including a higher number of patients not receiving SAT, is needed

The efficacy of suppressive antibiotic treatment in patients managed non-operatively for periprosthetic joint infection and a draining sinus

Objectives: Patients with prosthetic joint infections (PJIs) not suitable for curative surgery may benefit from suppressive antibiotic therapy (SAT). However, the usefulness of SAT in cases with a draining sinus has never been investigated. Methods: A multicentre, retrospective observational cohort study was performed in which patients with a PJI and a sinus tract were eligible for inclusion if managed conservatively and if sufficient follow-up data were available (i.e. at least 2 years). SAT was defined as a period of > 6 months of oral antibiotic therapy. Results: SAT was initiated in 63 of 72 (87.5 %) included patients. Implant retention during follow-up was the same in patients receiving SAT vs. no SAT (79.4 % vs. 88.9 %; pCombining double low line0.68). In total, 27 % of patients using SAT experienced side effects. In addition, the occurrence of prosthetic loosening in initially fixed implants, the need for surgical debridement, or the occurrence of bacteremia during follow-up could not be fully prevented with the use of SAT, which still occurred in 42 %, 6.3 %, and 3.2 % of cases, respectively. However, the sinus tract tended to close more often (42 % vs. 13 %; pCombining double low line0.14), and a higher resolution of pain was observed (35 % vs. 14 %; pCombining double low line0.22) in patients receiving SAT. Conclusions: SAT is not able to fully prevent complications in patients with a draining sinus. However, it may be beneficial in a subset of patients, particularly in those with pain or the hindrance of a draining sinus. A future prospective study, including a higher number of patients not receiving SAT, is needed

Potential value of a rapid syndromic multiplex PCR for the diagnosis of native and prosthetic joint infections: a real-world evidence study

Introduction: The BIOFIRE Joint Infection (JI) Panel is a diagnostic tool that uses multiplex-PCR testing to detect microorganisms in synovial fluid specimens from patients suspected of having septic arthritis (SA) on native joints or prosthetic joint infections (PJIs). Methods: A study was conducted across 34 clinical sites in 19 European and Middle Eastern countries from March 2021 to June 2022 to assess the effectiveness of the BIOFIRE JI Panel. Results: A total of 1527 samples were collected from patients suspected of SA or PJI, with an overall agreement of 88.4 % and 85 % respectively between the JI Panel and synovial fluid cultures (SFCs). The JI Panel detected more positive samples and microorganisms than SFC, with a notable difference on Staphylococcus aureus, Streptococcus species, Enterococcus faecalis, Kingella kingae, Neisseria gonorrhoeae, and anaerobic bacteria. The study found that the BIOFIRE JI Panel has a high utility in the real-world clinical setting for suspected SA and PJI, providing diagnostic results in approximately 1 h. The user experience was positive, implying a potential benefit of rapidity of results' turnover in optimising patient management strategies. Conclusion: The study suggests that the BIOFIRE JI Panel could potentially optimise patient management and antimicrobial therapy, thus highlighting its importance in the clinical setting