Федеральное государственное бюджетное учреждение «Российский ордена Трудового Красного Знамени научно-исследовательский институт травматологии и ортопедии имени Р.Р. Вредена» Министерства здравоохранения Российской Федерации, г. Санкт-Петербург, Россия Experimental study of antimicrobial polymeric composition with hemostatic effect in treatment of implant associated infection
Typical errors in rendering specialized care to patients with chronic periprosthetic infection after total hip arthroplasty are demonstrated on the example of one patient. The role of patient examination with due regard for the complication risk factors, insufficient alertness in respect to postoperative infectious complications, absence of continuity at the steps of surgical treatment, complexity of eradication of infectious agent and need of multidisciplinary approach for rendering care to this group of patients is specially emphasized.
Typical errors in rendering specialized care to patients with chronic periprosthetic infection after total hip arthroplasty are demonstrated on the example of one patient. The role of patient examination with due regard for the complication risk factors, insufficient alertness in respect to postoperative infectious complications, absence of continuity at the steps of surgical treatment, complexity of eradication of infectious agent and need of multidisciplinary approach for rendering care to this group of patients is specially emphasized.
Background. Chronic periprosthetic joint infection (PJI) remains the one among the most severe complications of total hip arthroplasty. Presence of sinus tract assosiated with polymicrobial infection development, complexity of bacteriological diagnostics and damage of soft tissues lead to constrictions of one-stage revision hip arthroplasty (RHA). The aim of this studywas to assess the influence of draining sinus tract on the outcomes of one-stage RHA in patients with chronic hip PJI.Materials and Methods.A prospective cohort comparative study included 78 patients who underwent one-stage RHA in 2017-2020. Two groups were formed: 48 (61.54%) patients without sinus tract (WST) and 30 (38.45%) patients with sinus tract (ST).Results. The presence of a sinus tract significantly increased the duration of a one-stage RHA in groups of ST and WST (230 and 197.5 min respectively, p = 0.02), as well as blood loss (850 ml and 700 ml, respectively, p = 0.046). Sinus tract was a reliable symptom of soft tissue local infectious inflammation (86.67%, p = 0.00031), fasciitis (36.67%, p = 0.012), purulent cavity (66.67%, p = 0.00027). The structure of the pathogens was comparable. Monobacterial infections predominated in the WST group (82.98%) and in the ST group (77.78%, p = 0.08). In most cases staphylococci were isolated. The median follow-up was 20 months for both groups. The PJI was healed in 93.0% (n = 28) patients in WST group and 82.2% (n = 43) in ST PJI (p>0.05). Postoperative evaluation in the WST and ST groups: HHS 92 and 90 points (p = 0.79), EQ-5D-5L – 0.82 and 0.78 points (p = 0.84) respectively. The proportion of patients who were indicated revision surgery with no PJI association in the ST group exceeded this indicator more than twice according to the WST group — 25 and 11.62%, respectively (p>0.05).Conclusion.As a result of the study, there was no statistically significant difference between the outcomes of one-stage RHA in patients with and without sinus tract. Factors such as the anamnesis morbi, the soft tissues condition at the surgical site and the pathogenic microflora characteristics should be taken into account in order to achieve favourable outcomes of surgical treatment.
Introduction The paper presents a comparative analysis of one-stage treatment of chronic osteomyelitis using tobramycin-impregnated calcium sulfate and β-tricalcium phosphate mixed with antibiotics impregnated hydroxyapatite to fill in the cavitary defect of long bones. Material and methods The retrospective group (group 1, n = 34) was treated with tobramycin-impregnated calcium sulfate (Osteoset T), and the prospective group (group 2, n = 25) received β-tricalcium phosphate mixed with antibiotics impregnated hydroxyapatite (ReproBone). Results and discussion There were no significant differences between the groups of patients by gender, age, type of osteomyelitis and duration of the disease. The differences in the operating time, intraoperative blood loss and the size of the cavitary bone defect post debridement were not significant between the groups. There were no significant differences in preoperative level of CRP between the groups, with CRP being higher (p = 0.02) in group 1 than in group 2, prior to the discharge from the hospital. Recurrence was seen in 35 % (n = 12) of group 1 and in 16 % (n = 4) of group 2 at a 21/2-year follow-up. The risk of recurrence was found to be 2.2 times greater with use of commercially available biocomposite loaded with tobramycin that that with β-tricalcium phosphate mixed with hydroxyapatite (HR 2.206; CI 0.806-6.038) impregnated with antibiotics administered with preoperative microbiological findings. Conclusion Combined β-tricalcium phosphate based biocomposites mixed with hydroxyapatite impregnated with broad-spectrum antibiotics showed greater efficacy for methicillin-resistant staphylococcus aureus in the treatment of chronic osteomyelitis filling cavitary bone defect of long bones as comp ared to tobramycin-impregnated calcium sulfate.
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