Manejo y resultados funcionales de las infecciones protésicas agudas

[spa] INTRODUCCIÓN: La realización de artroplastias totales de rodilla y cadera ha aumentado durante las últimas décadas como un método eficaz para mejorar el dolor y la movilidad articular en pacientes con artrosis o artritis reumatoide, en los que las medidas conservadoras no habían controlado el dolor ni mejorado la función. La infección es una de las complicaciones más graves y se asocia a una gran morbilidad, largas estancias hospitalarias, importante limitación funcional que disminuye la calidad de vida y un elevado coste económico. La mejora en las condiciones de higiene, la profilaxis antibiótica y los protocolos quirúrgicos han reducido la incidencia de infección, que actualmente se sitúa entorno al 2-4 % en prótesis primarias. PACIENTES Y MÉTODOS: 1)Se revisaron de forma retrospectiva los datos de las infecciones protésicas agudas causadas por Staphylococcus aureus y tratadas con un desbridamiento quirúrgico sin retirar el implante, durante el periodo comprendido entre Enero de 2000 y Octubre de 2007.2)De Enero del 2004 a Diciembre del 2006, todos los pacientes que se registraron en la base de datos con una infección aguda sobre una prótesis de rodilla, tratados sin retirar el implante y que al año de finalizar el tratamiento se consideraron curados fueron incluidos en el estudio de valoración funcional. RESULTADOS:1) 43 pacientes (69,4%) estaban en remisión, 11 recidivas (17,7%), 7 re-infecciones (11,3%) y 1 aflojamiento aséptico (1,6%). Un paciente murió como consecuencia de la infección (1,6%).El análisis CART identificó la PCR como el factor pronóstico más importante y estableció el punto de corte en un valor de 22,5 mg/dL (probabilidad de fracaso del 82,2% para valores superiores y del 35,3% para valores iguales o inferiores). 2) Los resultados del cuestionario de WOMAC basales (previo a la artroplastia) y a los 12 meses de seguimiento, muestran una mejoria funcional en estos pacientes, la mejoría fue estadísticamente significativa (p≤0,003) en las tres dimensiones del cuestionario WOMAC (dolor, rigidez y función) a los 12 meses de seguimiento. CONCLUSIONES:.- Las infecciones agudas postquirúrgicas sobre una prótesis de rodilla o cadera, debidas a S. aureus, tratadas con una limpieza quirúrgica con conservación del implante seguido de 7-10 días de tratamiento antibiótico intravenoso y un esquema de tratamiento oral basado en el uso de rifampicina a razón de 600 mg/24h, se asociaron a una tasa de curación superior al 70%. Los pacientes con una infección protésica aguda tratados con limpieza quirúrgica y retención del implante, a los 12 meses de seguimiento mejoran de forma significativa su capacidad funcional (WOMAC) con respecto a su situación antes de colocarse la prótesis articular.[eng] INTRODUCTION: The performance of total knee arthroplasty and hip has increased in recent decades as an effective method for improving pain and joint mobility in patients with osteoarthritis or rheumatoid arthritis. Infection is one of the most serious complications and is associated with significant morbidity. The improvement in hygiene, antibiotic prophylaxis and surgical protocols have reduced the incidence of infection, which currently stands at around 2-4% in primary prosthesis. PATIENTS AND METHODS: 1) retrospectively reviewed data from acute prosthetic infections caused by Staphylococcus aureus and treated with surgical debridement without removal of the implant, during the period between January 2000 and October 2007. 2) From January 2004 to December 2006, all patients were recorded in the database with an acute infection of a knee prosthesis, treated without removal of the implant and complete a year of treatment were considered cured were included in the study of functional evaluation. RESULTS: 1) 43 patients (69.4%) were in remission, 11 recurrences (17.7%), 7 re-infections (11.3%) and 1 aseptic loosening (1.6%). One patient died of infection (1.6%). The CART analysis identified CRP as the most important prognostic factor and set the cutoff at a value of 22.5 mg / dL (probability of failure of 82, 2% for values above and 35.3% for values up). 2) The results of the WOMAC questionnaire at baseline (pre-arthroplasty) and at 12 months follow-up showed a functional improvement in these patients, the improvement was statistically significant (p ≤ 0.003) in the three dimensions of the WOMAC questionnaire (pain, stiffness and function) at 12 months follow up. CONCLUSIONS: Acute infections postsurgical on a knee or hip, due to S. aureus, treated with a surgical scrub with preservation of the implant followed by 7-10 days of intravenous antibiotic therapy and oral treatment scheme based on the use of rifampicin at 600 mg/24 h, were associated with a cure rate exceeding 70%.Patients with acute prosthetic infection treated with surgical cleaning and retention of the implant at 12 months follow-up significantly improve their functional capacity (WOMAC) with respect to your situation before putting the joint prosthesis

Defectos óseos en artroplastia de revisión de rodilla tratados con aloinjerto óseo y plasma rico en plaquetas

ANTECEDENTES uno de los aspectos más desafiantes de la artroplastia de revisión de rodilla es el manejo de la pérdida ósea. OBJETIVO: demostrar la capacidad de incrementar la densidad mineral ósea en áreas con pérdida ósea, mediante el uso de plasma rico en plaquetas. MATERIAL Y MÉTODOS: estudio prospectivo, aleatorizado, cegado; efectuado con pacientes a quienes se realizó artroplastia de revisión de rodilla con pérdida ósea metafisiaria de tibia. Los pacientes se asignaron al azar a dos grupos para rellenar los defectos con aloinjerto óseo liofilizado con plasma rico en plaquetas (grupo experimental, n= 9), y otro grupo que sólo recibió el injerto óseo liofilizado (grupo control, n= 7). En ambos grupos la evaluación de la densidad mineral ósea se hizo con absorciometría de rayos X de energía dual (DXA) antes de la operación, al mes, seis meses, y un año después de la cirugía. RESULTADOS: se estudiaron 16 pacientes sin diferencias significativas entre ambos grupos en la densidad mineral ósea durante el periodo de seguimiento. CONCLUSIONES: el plasma rico en plaquetas no demostró incrementar la densidad mineral ósea en pacientes con defectos óseos por artroplastia de revisión de rodilla

Defectos óseos en artroplastia de revisión de rodilla tratados con aloinjerto óseo y plasma rico en plaquetas

ANTECEDENTES uno de los aspectos más desafiantes de la artroplastia de revisión de rodilla es el manejo de la pérdida ósea. OBJETIVO: demostrar la capacidad de incrementar la densidad mineral ósea en áreas con pérdida ósea, mediante el uso de plasma rico en plaquetas. MATERIAL Y MÉTODOS: estudio prospectivo, aleatorizado, cegado; efectuado con pacientes a quienes se realizó artroplastia de revisión de rodilla con pérdida ósea metafisiaria de tibia. Los pacientes se asignaron al azar a dos grupos para rellenar los defectos con aloinjerto óseo liofilizado con plasma rico en plaquetas (grupo experimental, n= 9), y otro grupo que sólo recibió el injerto óseo liofilizado (grupo control, n= 7). En ambos grupos la evaluación de la densidad mineral ósea se hizo con absorciometría de rayos X de energía dual (DXA) antes de la operación, al mes, seis meses, y un año después de la cirugía. RESULTADOS: se estudiaron 16 pacientes sin diferencias significativas entre ambos grupos en la densidad mineral ósea durante el periodo de seguimiento. CONCLUSIONES: el plasma rico en plaquetas no demostró incrementar la densidad mineral ósea en pacientes con defectos óseos por artroplastia de revisión de rodilla

The matrix synthesis and anti-inflammatory effect of autologous leukocyte-poor platelet rich plasma in human cartilage explants

Objective. To determine the effects of autologous leukocyte-poor platelet-rich plasma (LPPRP) on the expression of markers involved in cartilageextracellular matrix production and inflammation in cartilage explants bearing osteoarthritis. Materials and Methods. Cartilage explants and LP-PRP were obtained from 10 patients who underwent total knee arthroplasty. The explants were cultured in spinner flasks for 28 days in the presence of interleukin (IL)-1β and/or LP-PRP. The gene expression of catabolic (MMP13, ADAMTS5, and IL1β) and anabolic factors (COL2A1, ACAN, and SOX9) was quantified. A histological assessment was performed according to a modified Mankin score, and quantification of type II and I collagen deposition. Results. The gene expression of catabolic factors and the Mankin score were lower in LP-PRP- and LP-PRP/IL1β- than in IL-1β-treated explants, suggesting less matrix degradation in explants cultured in the presence of LP-PRP. Higher expression of genes involved in cartilage matrix restoration was observed in LP-PRP and LP-PRP/IL-1β- when compared to IL-1β-treated explants. The explants treated with LP-PRP and LPPRP/IL-1β exhibited a higher deposition of type II collagen as well as a lower deposition of type I collagen and also better surface integrity and a significant increase in the number of chondrocytes. Conclusion. LPPRP treatment favored restoration in early osteoarthritic cartilage and reduced the pro-inflammatory effect of IL1β. LP-PRP is a promising therapy for early osteoarthritis, as it promotes extracellular matrix repair, reduces inflammation, and slows cartilage degeneration

Fixed-bearing unicompartmental knee arthroplasty provides a lower failure rate than mobile-bearing unicompartimental knee arthroplasty when used after a failed high tibial osteotomy: a systematic review and meta-analysis

Data de publicació electrònica: 20-08-2021Despite the fact that the choice of bearing design has been thought to influence the functional outcomes and longevity of unicompartimental knee arthroplasty (UKA), there is a lack of clinical evidence supporting the decision-making process in patients who have undergone high tibial osteotomy (HTO). A systematic review of studies was carried out that reported the outcomes of fixed-bearing (FB) or mobile-bearing (MB) medial UKA in patients with a previous HTO. A random effect meta-analysis using a generalized linear mixed-effects model to calculate revision rates was done. Seven retrospective cohort studies were included for this study. Regarding the fixation method, 40 were the FB-UKA and 47 were MB-UKA. For both groups, the mean post-operative follow-up was 5.8 years. The survival rates were 92% for the FB-UKA with a mean follow-up of 10 years. For the MB-UKA, it ranged from 35.7 to 93%, with a mean follow-up of 4.2 years. For the FB, the time to revision was reported as 9.3 years, while 1.2, 2.5 and 2.91 years was reported for the MB. The results of the meta-analysis showed that the revision rate for the patients receiving a FB-UKA after failed HTO was 8%, compared to 17% in those who received an MB-UKA. The results of the review suggest that the use of the FB-UKA is associated with lower revision rates and a longer survival time than the MB-UKA and have similar functional ability scores.Level of evidence: III (systematic review of level-III studies)

MRI evaluation of the peripheral attachments of the lateral meniscal body: the menisco-tibio-popliteus-fibular complex

Data de publicació electrònica: 17-06-2021Purpose: To determine, identify and measure the structures of the menisco-tibio-popliteus-fibular complex (MTPFC) with magnetic resonance imaging (MRI) in knees without structural abnormalities or a history of knee surgery. Methods: One-hundred-and-five knees without prior injury or antecedent surgery were analyzed by means of MRI. The average age was 50.1 years ± 14.8. All the measurements were performed by three observers. The peripherical structures of the lateral meniscus body were identified to determine the location, size, and thickness of the entire MTPFC. The distance to other "key areas" in the lateral compartment was also studied and compared by gender and age. Results: The lateral meniscotibial ligament (LMTL) was found in 97.1% of the MRIs, the popliteofibular ligament (PFL) in 93.3%, the popliteomeniscal ligaments (PML) in 90.4% and the meniscofibular ligament (MFL) in 39%. The anteroposterior distance of the LMTL in an axial view was 20.7 mm ± 3.9, the anterior thickness of the LMTL was 1.1 mm ± 0.3, and the posterior thickness of the LMTL 1.2 mm ± 0.1 and the height in a coronal view was 10.8 mm ± 1.9. The length of the PFL in a coronal view was 8.7 mm ± 2.5, the thickness was 1.4 mm ± 0.4 and the width in an axial view was 7.8 mm ± 2.2. Conclusions: The MTPFC has a constant morphological and anatomical pattern for three of its main ligaments and can be easily identified and measured in an MRI; the MFL has a lower prevalence, considering a structure difficult to identify by 1.5 T MRI