- Klíčová slova
- estetická chiruragie nohy,
- MeSH
- estetika MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony * MeSH
- noha (od hlezna dolů) * chirurgie MeSH
- Check Tag
- lidé MeSH
- MeSH
- deformity nohy (od hlezna dolů) * chirurgie etiologie MeSH
- diabetická noha chirurgie patologie MeSH
- diabetické neuropatie chirurgie komplikace MeSH
- komplikace diabetu * MeSH
- lidé MeSH
- miniinvazivní chirurgické výkony * MeSH
- prsty nohy chirurgie patologie MeSH
- syndrom kladívkového prstu chirurgie etiologie MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY No study has so far been published in the Czech Republic that would try to at least estimate the costs associated with revision total knee arthroplasties (TKA). The purpose of our study was to determine the total costs of primary and revision TKA for aseptic and septic failure and to determine the structure of costs, all with respect to a single workplace in the Czech Republic. MATERIAL AND METHODS The group included a total of 43 patients aged 55 to 82 years, of whom 23 (53.5%) with primary TKA implantation, 10 (23.3%) patients with revision surgery for aseptic failure, and 10 patients for septic failure of TKA. The costs of TKA were calculated retrospectively, factoring in all the items of reported care sent to the health insurance company system. The resulting costs reflected the appropriate payments in CZK based on the point value in the year concerned. RESULTS The average costs of uncomplicated primary TKA implantation amounted to CZK 136,279; the surgical treatment of aseptic failure of TKA was CZK 189,634; and the surgical treatment of septic failure of TKA was CZK 296,189. In all the evaluated cases, the highest cost item was the material of the implant (43.5 to 54.2% of the total costs), followed by the bed costs (19.8 to 21.6%), and the third highest cost item being the performance of surgery (13.6 to 16.5%). The costs of the physician ́s services represented 12.8 to 14.7% of the total costs and 23.6 to 33.8% of the costs of the implants. The costs associated with the treatment of infection by multiple-stage reimplantation were 5.4 times higher than when DAIR (revision surgery with debridement, irrigation, original implant retention) was used. The average costs of inpatient rehabilitation accounted for CZK 23,046 and the insurance company reimbursed on average CZK 33,544 for a 4-week therapeutic spa treatment. DISCUSSION The finding that the revision TKA is several times more expensive than the primary TKA and that the multiple-stage total knee reimplantation is the most expensive corresponds with the literature. In the Czech Republic, the dominant cost item is the cost of the implant, namely in the total costs of both the primary and revision TKA, with the revision implants in our study being on average 2.1 times more expensive than the implants used for primary implantation. Besides, the costs of implants also considerably differ across countries. The costs of the physician ́s services ranked 4th in the list of cost items, which does not correspond with the data reported in Western Europe or the US. Conversely, the least difference was observed in the costs of preoperative preparation and auxiliary examinations. CONCLUSIONS We have concluded in our study that the average costs of the total knee replacement for aseptic failure were 1.9 times higher than the costs of primary surgery. The average costs of treatment for septic failure (two-stage procedure) were 2.7 times higher compared to primary surgery. In case of aseptic failure, the costs of total knee reimplantation were 2.7 times higher compared to the replacement of only polyethylene liner in case of instability and osteosynthesis in case of periprosthetic fracture, with components retention. The costs of septic failure therapy were 5.4 times higher in multiple-stage reimplantation compared to revision surgery with debridement, irrigation and original implant retention.
- MeSH
- infekce chirurgické rány ekonomika komplikace MeSH
- lidé středního věku MeSH
- lidé MeSH
- náklady na zdravotní péči MeSH
- pooperační péče ekonomika MeSH
- reoperace * ekonomika MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene * ekonomika MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- práce podpořená grantem MeSH
- tabulky MeSH
Úvod: Chirurgický steh je nedílnou součástí každého operačního přístupu a základní podmínkou zhojení operační rány. Cílem studie bylo popsat naši modifikaci pokračujícího stehu podkoží u totální náhrady kyčle a kolene s několika kontrolními uzly. Současně jsme chtěli určit základní klinické vlastnosti naší techniky, zejména vztah k adaptaci kůže a výskytu komplikací hojení. Metoda a materiál: Sledovaný soubor tvořilo 80 pacientů. V souboru bylo 20 pacientů s primoimplantací totální endoprotézy kyčle a 20 pacientů s primoimplantací totální endoprotézy kolena, u kterých byla provedena sutura podkoží pokračujícím stehem v naší modifikaci. Kontrolní skupina zahrnovala také 20 pacientů s primoimplantací totální endoprotézy kyčle a 20 pacientů s primoimplantací totální endoprotézy kolena, u kterých byla provedena sutura podkoží jednotlivými stehy. Peroperačně jsme sledovali čas provedení sutury podkoží. Pooperačně jsme během období tří měsíců po operačním výkonu sledovali výskyt komplikací, které by mohly mít souvislost s technikou uzávěru rány. Výsledky: U pacientů se suturou podkoží v naší modifikaci jsme peroperačně změřili průměrnou délku provedení sutury u totální endoprotézy kyčle v délce 7,9 minuty, u totální endoprotézy kolena v délce 9,3 minuty. U pacientů, kteří tvořili kontrolní skupinu, byla průměrná délka sutury podkoží u totální endoprotézy kyčle 9,1 minuty a u totální endoprotézy kolene 10,5 minuty. Pooperačně jsme nezaznamenali u žádného pacienta v souboru maladaptaci kůže, dehiscenci v ráně nebo infekční komplikaci v průběhu tříměsíčního pooperačního sledování. Závěr: Pokračující steh podkoží se dnes sice běžně provádí, avšak v naší modifikaci spatřujeme jeho nepochybné vylepšení, zvláště ve smyslu pevnosti a odolnosti sutury (prevence rozpadu). Pojistné uzly ránu nedráždí ani nepřepínají. Během tříměsíčního pooperačního sledování pacientů jsme nezaznamenali žádný výskyt komplikací primárního hojení rány.
Introduction: Sutures are an integral part of any surgical procedure and a prerequisite for surgical wound healing. The study aimed to describe our modification of running subcuticular suture with several knots after total hip and knee arthroplasty. Another objective was to determine the basic clinical properties of our technique, in particular its association with skin adaptation and the occurrence of healing complications. Methods: The sample comprised 80 patients. There were 20 patients with primary total hip arthroplasty and 20 patients with primary total knee arthroplasty in whom the modified running subcuticular suture technique was used. A control group included another 20 patients with primary total hip arthroplasty and 20 patients with primary total knee arthroplasty in whom simple interrupted sutures were used to close the subcutaneous tissue. During the surgery, the time needed to place subcuticular sutures was recorded. For three months postoperatively, the development of complications potentially associated with the wound closure technique was documented. Results: The mean times of modified subcuticular suturing were 7.9 and 9.3 minutes for total hip and knee arthroplasty, respectively. In controls, the mean times of subcuticular suturing were 9.1 and 10.5 minutes for total hip and knee arthroplasty, respectively. Over the 3-month postoperative period, inadequate skin adaptation, wound dehiscence or infectious complications were not observed in any of the patients. Conclusion: Although running subcuticular sutures are routinely performed today, the modified approach is a clear improvement of the technique, in particular the strength and durability of sutures (preventing them from breaking). The knots neither irritate nor place strain on the wound. Over a 3-month postoperative follow-up, no complications with primary wound healing were observed in the patients.
- MeSH
- artroplastiky kloubů metody trendy využití MeSH
- epidermis chirurgie MeSH
- hojení ran fyziologie imunologie účinky léků MeSH
- kožní systém chirurgie MeSH
- kůže MeSH
- lidé MeSH
- náhrada kyčelního kloubu * metody trendy využití MeSH
- ortopedické výkony metody škodlivé účinky MeSH
- pooperační komplikace MeSH
- škára chirurgie MeSH
- statistika jako téma MeSH
- studie případů a kontrol MeSH
- sutura * normy využití MeSH
- techniky uzavření rány normy využití MeSH
- totální endoprotéza kolene * metody trendy využití MeSH
- Check Tag
- lidé MeSH
PURPOSE OF THE STUDY Radiolucent (RL) lines may appear around the total knee arthroplasty (TKA); they occur much more frequently under the tibial component than under the femoral one. The RL lines are gaps between the TKA and the cement, or between the cement and the bone bed. They are clearly visible immediately after the surgery or may appear later. They constitute pathology of the interface and are subject to research mainly due to their potential association with aseptic loosening. The aim of this study was to assess how often they are clearly visible on the first postoperative radiograph in everyday clinical practice, how they develop during the following two years, and to compare the results with the available professional literature. Another aim was to assess the relation between RL lines and the alignment of components, the patient's habitus and clinical outcomes of the surgery. MATERIAL AND METHODS The group included 62 patients with a total number of 69 TKA implants, of which 28 were men (45.2%) and 34 women (54.8%) aged 46 to 79 years of age. The occurrence of RL lines was monitored on the first postoperative radiograph and subsequently at a one-year interval during the following 2 years. The location of RL lines and the placement of components were assessed radiographically in terms of the concept by Meneghini et al. The evaluation of surgical outcomes was done using the Knee Society Score (KSS), and the habitus was assessed with the BMI index. Subjective evaluation of the surgical outcome was done using the 4-point satisfaction scale. RESULTS The first postoperative radiographs showed a RL line at 9 (0.8%) locations in 9 (13.0%) TKAs. The control radiographs made 1 year after the surgery showed a RL line at 42 (3.8%) locations in 29 (42.0%) TKAs. During the last check conducted 2 years after the surgery, a RL line was detected at 60 (5.4%) locations in 33 (47.8%) TKAs. Throughout the follow-up period, progression of the existing RL line occurred at 6 locations in 6 (8.7%) TKAs. On the very contrary, the RL line disappeared at 8 locations in 6 (8.7%) TKAs. An association was found between the RL line occurrence and postoperative limb axis (a higher risk was posed by the varus deformity). Moreover, the frequency of RL lines increased with the growing BMI value. No relation was found between the KSS and satisfaction with the surgery and the occurrence of RL lines. DISCUSSION AND CONCLUSIONS The occurrence of RL lines corresponds roughly with the frequency stated in literature. Some lines show progression, other disappear. So far, we have been unable to distinguish the predictively significant RL lines from the insignificant ones. Important will undoubtedly also be the size of surface of RL lines and their cause. More frequent RL lines were observed in the postoperative varus deformity of TKA and with the growing BMI value. The RL lines under the anterior part of the femoral component showed a tendency to progress. In order to avoid them we recommend modifying the cementing technique. Clinically significant is the fact that the RL lines occurrence correlates neither with subjective nor with clinical outcomes of the surgery. Key words: total knee arthroplasty; total knee replacement; radiolucent lines; progression; alignment; Knee Society Score; BMI.
- MeSH
- index tělesné hmotnosti MeSH
- kolenní kloub diagnostické zobrazování MeSH
- kostní cementy MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- pooperační období MeSH
- protézy kolene MeSH
- radiografie MeSH
- senioři MeSH
- spokojenost pacientů MeSH
- totální endoprotéza kolene metody MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
