- Publikační typ
- abstrakt z konference MeSH
- Publikační typ
- abstrakt z konference MeSH
- 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 Trapeziometacarpal osteoarthritis affects primarily postmenopausal middle-aged and older women. Total joint replacement is one of the surgical treatment options for symptomatic advanced degenerative changes of the carpometacarpal joint. This study aims to evaluate the short-term functional and radiological results of the Ivory ® prosthesis with the minimum followup period of three years after the surgery. MATERIAL AND METHODS Presented are the results of 48 total trapeziometacarpal joint replacements in the group of 40 patients composed of 36 women and 4 men. The age of patients ranges from 41 to 75 years (median 56 years), with the ratio between the dominant and non-dominant upper extremity 23:25. The follow-up period ranged from 36 to 63 months (median 52 months). The surgery was indicated in patients with symptomatic trapeziometacarpal arthrosis of stage II, III and early stage IV according to Eaton-Glickel once the conservative therapy had failed. In all the patients, the evaluation of the function and pain of the operated joint by DASH score, the range of motion -thumb opposition by Kapandji score were carried out at regular intervals pre- and postoperatively, the radiological evaluation of the stage of degenerative joint condition was done preoperatively, whereas the position of the implant and the lengthening of the first column of the finger were assessed postoperatively. RESULTS Subjectively, the patients were satisfied with the result of the surgery. After the joint replacement, in 65% of cases the patients reported full satisfaction with no difficulties present, in 31% of cases the patients suffered from pain during loading, in 4% of cases the patients reported also occasional pain at rest. Postoperatively, the total DASH score values decreased from the mean preoperative value of 52.79 to 10.4 points at a three-year follow-up. The average value of pain dropped from 3.46 to 1.44 points 3 years after the surgery. The average range of motion - thumb opposition by Kapandji score increased from 8.57/10 to 9.85/10 one year after the surgery. The difference between the values of average increase in length of the first column of the finger was 0.14 mm in favour of the sub-group of symptomatic cases. In the evaluated group, the need for revision was determined in 4 implants. In 1case for aseptic loosening of the cup and three times for dislocation. After 36 months, 47 of 48 implants were in situ, the overall three-year survival was achieved in 97.9%. The most frequent postoperative complication was the occurrence of De Quervain s tenosynovitis (10%). DISCUSSION Currently, most of the newer types of modular uncemented hydroxyapatite-coated total "ball and socket" joint replacements present acceptable medium-term, and in some cases even long-term, results regarding the survival. The most pressing issue continues to be the survival of implants, particularly the failure of the trapezial component and the associated risk of revision surgery. Good postoperative results can be achieved by accurate indication, carefully applied cup implant and good postoperative cooperation of patients. The complementary study did not confirm that the lengthening of the thumb causes the postoperative development of De Quervain s tenosynovitis. CONCLUSIONS The uncemented first carpometacarpal joint total replacement using the Ivory ® prosthesis brings about very good shortterm functional and radiological results, with no occurrence of early aseptic loosening of the implant. Key words:rhizarthrosis, arthroplasty, carpometacarpal joint prosthesis, uncemented.
- MeSH
- artroplastiky kloubů škodlivé účinky přístrojové vybavení metody MeSH
- dospělí MeSH
- karpometakarpální klouby diagnostické zobrazování chirurgie MeSH
- lidé středního věku MeSH
- lidé MeSH
- následné studie MeSH
- osteoartróza diagnostické zobrazování chirurgie MeSH
- pooperační komplikace MeSH
- protézy kloubů * MeSH
- radiografie MeSH
- senioři MeSH
- spokojenost pacientů MeSH
- trapézová kost chirurgie MeSH
- výsledek terapie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- senioři MeSH
- Publikační typ
- časopisecké články MeSH
