Jessenius
842 stran : barevné ilustrace ; 27 cm
Publikace se zaměřuje na infekční komplikace při různých ortopedických onemocněních. Určeno odborné veřejnosti.
- Conspectus
- Ortopedie. Chirurgie. Oftalmologie
- NML Fields
- ortopedie
- infekční lékařství
- NML Publication type
- kolektivní monografie
PURPOSE OF THE STUDY The purpose of the study is to analyse the number of adult patients treated in our department for native joint septic arthritis and to outline guidelines for antibiotic therapy. MATERIAL AND METHODS From the beginning of 2003 to the end of 2020, a total of 36,342 surgeries were performed at our department. We retrospectively reviewed and analysed all surgeries for native joint septic arthritis (a total of 538 surgical interventions). The study included all adult patients who were operated for native joint septic arthritis in our department in 2003-2020. We included all revision surgeries for ongoing infection (excluding the management of post-infectious findings) as well as all operations performed in patients with multiple joint involvement. Based on the analysis of our data and review of published guidelines for antibiotic treatment of septic arthritis, we have outlined our own antibiotic therapy guidelines for the treatment of native joint septic arthritis. RESULTS From 2003 to 2020 we performed a total of 36,342 surgeries, of which 538 (1.5%) in 461 patients was indicated for native joint septic arthritis. The cohort consisted of 292 men (63%), who underwent 344 surgeries, and 169 women, in whom 194 surgeries were performed. The mean age of patients irrespective of the arthritis location was 62.4 years. Altogether, 19 patients (4.1%) suffered from multi-joint arthritis. The most frequently operated joint was the knee with 252 (54%) patients and 300 surgeries (56%), followed by the shoulder with 68 (14.7%) patients and 78 (14.5%) surgeries, the hip with 38 (8.2%) patients and 42 surgeries (8%), the carpal with 30 (6.5%) patients and 35 (6.5%) surgeries, the ankle with 25 patients (5.4%) - 31 (6%) surgeries, the small finger joints with 22 (4.75%) patients and 23 (4%) surgeries, the elbow with 14 (3%) patients and 14 (2.6%) surgeries, the sternoclavicular joint with 9 (1.9%) patients and 12 (2.2%) surgeries and the acromioclavicular joint with 3 patients and 3 (0.5 %) surgeries, respectively. DISCUSSION The management of septic arthritis relies heavily on early diagnosis, early surgical intervention and adequate antibiotic therapy. The diagnostic process and surgical treatment have their specifics related to the affected location, therefore, respective guidelines will be published separately for each location including the results. On the other side, antibiotic management is not dependent on the location and therefore the guidelines are included in this first analysis septic arthritis in the whole cohort. CONCLUSIONS Septic arthritis in adults in an ongoing issue with rising incidence. Early diagnosis, urgent and adequate surgical treatment, and optimal antibiotic therapy are preconditions for successful outcome. Key words: native joint septic arthritis, incidence, antibiotic therapy, guidelines.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Adult MeSH
- Incidence MeSH
- Arthritis, Infectious * diagnosis drug therapy epidemiology MeSH
- Knee Joint MeSH
- Middle Aged MeSH
- Humans MeSH
- Retrospective Studies MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY Tantallum trabecular metal implants (Trabecular Metal Technology - TMT) considerably changed the acetabular reconstruction options in revision surgeries with extensive bone defects and distorted pelvic ring integrity. The purpose of this study is to ascertain the short-term to medium-term outcomes of acetabular reconstruction through TMT implants in patients with Paprosky type 3a and 3b acetabular defects and in case of pelvic discontinuity. MATERIAL AND METHODS The prospective monocentric study included patients in whom the revision of acetabular components in total hip arthroplasty was performed, the acetabular defect was classified as Paprosky 3a and higher, a TMT implant was used for reconstruction, and the follow-up period was at least 2 years after surgery. In total, 87 patients who had met the inclusion criteria were operated on and followed-up. The patients in the study group underwent a clinical examination, an X-ray and also an assessment using the Harris hip score. Moreover, the patients were asked about their satisfaction with the surgical outcome, their willingness to undergo the same procedure again in case of difficulties, and they were also asked to rate the outcome in percentage term and by assigning grades. Also, an analysis of the reasons for revision and subsequent complications was carried out. Implant integration and its migration were evaluated on an X-ray. RESULTS 32 men and 55 women were subjects to evaluation, with a balanced number of operated sides (44:43 in favour of the right side). One-stage procedures prevailed, which were performed in a total of 74 cases, while two-stage revisions were performed in 13 cases in the study group. In three patients (3.5%) pelvic discontinuity was diagnosed, 69 patients (79%) suffered from Paprosky 3a defect and 15 patients (17%) from Paprosky 3b defect. The first patients underwent surgery in 2009 and the mean follow-up period in the study group was 48 months. In 1 patient the TMT implant was removed for infectious complications, in the remaining part of the group the TMT implant was fully integrated with no signs of loosening or migration in the monitored period. In the assessment using the Harris hip score, the mean score of 80.4 (range 36-99) was achieved. When assessing the satisfaction with the surgical outcome, the mean value achieved was 94.4%, and the mean assigned grade was 1.26 (on a school grading scale). DISCUSSION Extensive bone defects and pelvic discontinuity represent an issue in revisions of the acetabular component in total hip arthroplasty. There are several options how to address these conditions. State-of-the-art TMT implants thanks to their shortterm and medium-term outcomes appear as one of the most beneficial option with a low failure rate both in our study group and in published papers. CONCLUSIONS Evaluation of this monocentric prospective study reveals encouraging short-term and medium-term outcomes of the use of TMT implants in managing extensive acetabular bone defects of Paprosky 3a and 3b type and supports their further introduction into practice at our department. Key words: total hip arthroplasty (THA), revision implantation, TMT implant.
- MeSH
- Acetabulum diagnostic imaging surgery MeSH
- Hip Prosthesis * adverse effects MeSH
- Humans MeSH
- Arthroplasty, Replacement, Hip * adverse effects MeSH
- Follow-Up Studies MeSH
- Prospective Studies MeSH
- Prosthesis Design MeSH
- Reoperation MeSH
- Retrospective Studies MeSH
- Prosthesis Failure MeSH
- Tantalum MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY The study aims to quantify the costs of a hospital stay of patients with periprosthetic joint infection after total hip arthroplasty throughout the period of treatment. MATERIAL AND METHODS The group included patients who have been treated at our department for infection as a complication of total hip replacement since 1 January 2011, who have been provided with treatment (including complications) exclusively at the departments of Nemocnice České Budějovice, a.s. and whose treatment can be considered completed in 2019. The patients were included in the study regardless of the type of infection and method of treatment. The group consisted of 36 patients (16 men and 20 women). There were 3 cases of early postoperative infection, 14 cases of late postoperative infection and 19 cases of hematogenous infection. The group includes 8 patients treated by a one-stage reimplantation, 19 patients managed by a two-stage reimplantation, 6 patients treated by a revision surgery with implant retention, and 3 patients in whom only the implant removal was possible. In selected patients, all the reported points for all the hospital stays and costs incurred on a separately charged material were ascertained and the final sum was compared with the reimbursement obtained by the hospital in the DRG system valid for the respective year of treatment. The total costs were analysed and also an analysis by type of infection and method of treatment was carried out. RESULTS The average costs of managing infection as a complication of total hip arthroplasty at our department amounted to CZK 320 065 (CZK 56 995 - CZK 953 614), the reimbursement in respect of the monitored cases in the DRG system equalled CZK 220 503 (CZK 89 149 - CZK 589 974). The aforementioned suggests that the average loss per treated patient is CZK 99 562 (CZK + 63 372 - CZK -428 499). DISCUSION Care associated with infections as a complication of total hip arthroplasty is very costly and these costs are not fully covered by the reimbursement from the health insurance companies. In the Czech Republic, these costs have not been quantified as yet, therefore it is only possible to compare the costs with international publications arriving at similar conclusions and with own monitoring of the costs of periprosthetic joint infections after total hip arthroplasty. The most economically efficient is the one-stage replacement which, however, is not suitable for all the patients, and the two-stage reimplantation continues to be the gold standard. In our study, the most expensive was found to be the treatment of periprosthetic joint infection after total hip arthroplasty, in which also the highest financial loss is reported. CONCLUSIONS Due to the very high costs of treatment for periprosthetic joint infections after total hip arthroplasty, it is necessary to exert maximum efforts to prevent periprosthetic joint infections and to consider a change in the method of financing, particularly in centres to which patients are referred from other centres in order to make this treatment economically viable. Key words:total hip arthroplasty, PJI - periprosthetic joint infection, economic analysis.
- MeSH
- Length of Stay economics MeSH
- Prosthesis-Related Infections economics etiology surgery MeSH
- Humans MeSH
- Arthroplasty, Replacement, Hip adverse effects economics MeSH
- Device Removal economics MeSH
- Reoperation economics MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
PURPOSE OF THE STUDY The study aims to quantify the costs of a hospital stay of patients with total knee periprosthetic joint infection throughout the period of treatment. MATERIAL AND METHODS The group included patients who have been treated at our department for infection as a complication of total knee replacement since 1 January 2011, who have been provided with treatment (including complications) exclusively at the departments of Nemocnice České Budějovice, a.s. and whose treatment can be considered completed in 2018. The patients were included in the study regardless of the type of infection and method of treatment. The group consisted of 24 patients (11 men and 13 women). There were 2 cases of early postoperative infection, 6 cases of late postoperative infection and 16 cases of hematogenous infection. The group includes 17 patients treated by a two-stage reimplantation, 6 patients treated by a revision surgery with implant retention, and 1 patient treated by a one-stage replacement. In selected patients, all the reported points for all the hospital stays and costs incurred on a separately charged material were ascertained and the final sum was compared with the reimbursement obtained by the hospital in the DRG system valid for the respective year of treatment. The total costs were analysed and moreover, an analysis by type of infection and method of treatment was carried out. RESULTS The average costs of managing infection as a complication of TKA in our department amounted to CZK 405 864 (CZK 66 768-CZK 181 17). The average cost of a two-stage revision was CZK 497 487, the cost of a revision surgery with original implant retention was CZK 175 312. The reimbursement in respect of the monitored cases in the DRG system equalled CZK 276 230 (CZK 40 943-CZK 848 401). The aforementioned suggests that the average loss per a treated patient is CZK 129 635 (CZK + 26 066Kč-CZK -332 774). DISCUSION Our study is in agreement with recent literature, when confirming that the care associated with infections as a complication of TKA is very costly (especially in case of a two-stage reimplantation) and also that this care is not fully covered by the health insurance company. The reimbursement made by the health insurance companies does not cover on average 1/3 of the costs of care for an infectious patient. Theoretically, the reasons behind the reduced reimbursement may be sanctions which, however, cannot be accepted in case of late hematogenous infections which constituted more than 50% in our group. CONCLUSIONS Our study presented the actual costs associated with the care of TKA infection. It makes sense that the most expensive is the two-stage reimplantation, which is nevertheless still considered to be the gold standard procedure in chronic TKA infection. High costs of therapy together with the requirement of expert care would justify the introduction of care provided by specialised centres. In this case, centralisation could result in a more efficient use of funds and improvement of the quality of provided care. Key words:total knee arthroplasty, PJI - periprostetic joint infection, economic analysis. ÚVOD.
- MeSH
- Length of Stay economics MeSH
- Prosthesis-Related Infections economics etiology surgery MeSH
- Knee Joint surgery MeSH
- Humans MeSH
- Reoperation economics MeSH
- Arthroplasty, Replacement, Knee adverse effects economics MeSH
- Insurance, Health, Reimbursement economics MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Infekce totálních kloubních náhrad zůstávají jednou z nejzávažnějších komplikací těchto výkonů. Existují různé typy infektů. Některé typy infekce totální náhrady je obtížné odlišit od aseptického uvolnění. Často se prezentují pouze časným uvolněním implantátu nebo perzistující bolestí bez celkových příznaků infekce. K diagnostice infekce kloubní náhrady je často potřeba kombinace předoperačních a peroperačních vyšetření. Úspěšná léčba závisí na adekvátním chirurgickém výkonu kombinovaném s dlouhodobým podáváním antibiotik včetně antibiotik pronikajících do biofilmu. V tomto článku prezentujeme přehled diagnostiky a léčby infektů kloubních náhrad.
Prosthetic joint infection (PJI) remains one of the most serious complications of prosthetic joint implantation. There are different types of PJI. Low grade infections in particular are difficult to distinguish from aseptic failure, often presenting only with early loosening and persisting pain, or no clinical signs of infection at all. A combination a preoperative and intraoperative tests is usually needed for an accurate diagnosis of infection. Successful treatment requires adequate surgical procedure combined with long-term antimicrobial therapy, ideally with an agent acting on adhering stationary phase microorganisms. Diagnosis and treatment of prosthetic joint infections are reviewed in this article.
- MeSH
- Algorithms MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Arthroplasty, Replacement * adverse effects MeSH
- Bacterial Infections diagnosis microbiology MeSH
- C-Reactive Protein MeSH
- Debridement MeSH
- Prosthesis-Related Infections * diagnosis drug therapy surgery MeSH
- Humans MeSH
- Decision Support Techniques MeSH
- Postoperative Complications diagnosis drug therapy surgery MeSH
- Joint Prosthesis adverse effects MeSH
- Punctures MeSH
- Reoperation MeSH
- Synovial Fluid cytology microbiology MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
PURPOSE OF THE STUDY This study aims to articulate regional guidelines for curative and suppressive antibiotic therapy of total joint replacement infections. MATERIAL AND METHODS When developing the standard, used as source materials were the published foreign guidelines for antibiotic therapy of prosthetic joint infections, the analysis of resistance of bacterial strains conducted in the Hospital in České Budějovice, a.s. and the assessment of strain resistance for the Czech Republic published by the European Antimicrobial Resistance Surveillance Network (EARS-Net). Considered was also the availability of individual antibiotics in the Czech Republic and restricted prescription according to the Summary of Product Characteristics as specified in the State Institute for Drug Control marketing authorisation. The expert group composed of orthopaedists, microbiologists and infectious disease specialists elaborated the basic antibiotic guideline for choosing an appropriate antibiotic/antifungal drug based on the usual susceptibility, its dose and dosage interval for initial and continuation therapy. The comments of individual specialists were gradually incorporated therein and in case of doubts majority rule was applied. The drafted document was sent for peer reviews to clinical orthopaedic, infectious disease and microbiological centres, whose comments were also incorporated and the finalised document was submitted for evaluation to specialised medical societies. RESULTS The outcome is the submitted guideline for antibiotic curative and suppressive therapy suitable for managing the prosthetic joint infections, which was approved by the committee of the Czech Society for Orthopaedics and Traumatology andthe Society for Infectious Diseases of the Czech Medical Association of J. E. Purkyně. DISCUSION Curative therapy of total joint replacement infections consists primarily in surgical treatment and has to be accompanied by adequate antibiotic therapy administered initially intravenously and later orally over a sufficient period of time. Bearing in mind the wide spectrum of pathogens that can cause infections of a joint replacement and their capacity to form a biofilm on foreign materials, the correct choice of an antibiotic, its dose and dosage interval are essential for successful treatment. Such standard should respect regional availability of antibiotics, regional pathogen resistance/susceptibility and ensure the achievement of sufficiently high concentrations at the requested location including anti-biofilm activity. CONCLUSIONS The submitted guideline is not the only treatment option for joint total replacement infections, but it makes the decisionmaking easier when treating these complications in the form of infections. The final choice of an antibiotic, its dose and duration of therapy shall be based on a critical assessment of results of microbiological (blood culture and molecular genetic) tests and reflect the patient s clinical condition. Since these are multidisciplinary issues, we consider useful for this guideline to be commented upon and approved by the committee of both the Society for Orthopaedics and Infectious Diseases so that it can become the starting point for treatment. Key words: total joint replacement infection, TEP, ATB, antibiotic therapy, consensus meeting, guideline.
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Arthroplasty, Replacement adverse effects instrumentation MeSH
- Prosthesis-Related Infections diagnosis etiology therapy MeSH
- Humans MeSH
- Joint Prosthesis adverse effects MeSH
- Practice Guidelines as Topic MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Czech Republic MeSH
- Keywords
- artroskopie kyčelního kloubu,
- MeSH
- Diagnostic Imaging methods MeSH
- Hip Joint * diagnostic imaging MeSH
- Humans MeSH
- Surgical Clearance methods MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
