Despite the evolution of the total knee and hip arthroplasty surgery, high postoperative complication rates in the short and long term still persist. Infection is one of the most challenging complications; due to its gravity and treatment difficulties, prophylaxis protocols have been created to decrease its incidence. The objective of this study was to evaluate the impact of the prophylaxis protocol for methicillin-resistant Staphylococcus aureus decolonization of the nares in patients previously identified by swab cultures, who were to be submitted to a total joint arthroplasty. A systematic review with meta-analysis was conducted, following the PRISMA-2015 protocol, using the descriptors: “arthroplasty” and “nasal decolonization,” or “joint arthroplasty” and “decolonization,” or “joint arthroplasty” and “nasal decolonization,” for final selection of four observational studies from 79 references identified. This study included a total sample of 10,179 patients, divided in two groups: the control group (4788 patients) and intervention group (5391 patients). It was observed that the intervention group, in which prophylaxis with nasal decolonization was used, 59 (1.09%) of the patients developed a surgical site infection, while in the control group there were 86 cases of surgical site infection (1.79%). This trend repeated itself in all articles, showing no publication biases, forming a homogeneous sample. The use of a prophylaxis protocol for decolonization of methicillin-resistant Staphylococcus aureus, reduced surgical site infection cases by approximately 39%.
BackgroundThere are several reports on anatomical differences of the meniscus. However, there are only a few reports on abnormalities in both menisci and anatomical differences in anterior cruciate ligament insertions.Case presentationThis is a case report of a 36-year-old Hispanic man presenting symptoms, including knee pain, locking, and effusion, with an anatomical abnormality of the menisci corresponding to the fusion of the posterior horns of the menisci in tandem with the insertion of the posterior meniscus fibers in the anterior cruciate ligament.ConclusionsThis is the first study describing a meniscus anatomical variant with isolated posterior junction of the posterior horn with an anomalous insertion to the anterior cruciate ligament. The recognition of meniscus variants is important as they can be misinterpreted for more significant pathology on magnetic resonance images.
Objective: Describe the clinical and epidemiological profile of patients undergoing total hip arthroplasty by analyzing the correlations between gender and indication of surgery and postoperative complications. Methods:Cross-sectional study in retrospective approach of the medical records of patients undergoing total hip arthroplasty in a private Hospital in Salvador, Bahia in 2013 and 2014.Results: 66, 3% of patients are women, aged between 71 and 80 years (31, 2%), systemic arterial hypertension patients (63, 9%), whose major indication occurred coxarthrosis (48, 2%) followed by hip fracture (39, 8%); mostly by falling from height (66, 7%). Among the complications, anemia prevailed (53%) and death occurred in only 2, 4%. By correlating sex with indication of arthroplasty, hip fracture was only statistically significant in women (p=0.004); in complications, anemia (p=0.024) and urinary tract infection (p=0.025) had statistically significance in women and in men genitourinary changes (p<0.001). Conclusions:Patients undergoing hip arthroplasty are elderly, female, hypertensive, most of whose procedures ran from coxarthrosis or hip fracture. Among the complications prevailed anemia, genitourinary, cardiovascular and digestive changes. Hip fracture, anemia and urinary tract infection are significantly more prevalent in females, while the genitourinary changes are significant in males.
OBJECTIVE:To compare the effectiveness of patellar denervation versus non-patellar denervation in reducing anterior knee pain on a follow-up period of at least one year after total knee arthroplasty. METHOD: Data from 84 patients, who underwent total knee arthroplasty were analyzed. Participants were divided into 2 groups; group A: 42 patients who previously underwent total knee arthroplasty with patellar denervation; and group B: 42 patients who previously underwent total knee arthroplasty without patellar denervation. Results were evaluated using WOMAC and KSS questionnaires, and the VAS pain measurement. Knee ranges of motion were measured. Preoperative clinical conditions of both groups were similar. RESULTS: Postoperatively, the following results were observed. (a), the WOMAC scores for group A were significant better when compared to group B (27.95 ± 5.89 vs. 33,55 ± 6.23; (b) better results were also found in KSS scores for group A vs. group B (86.19 ± 7.10 vs. 83,07 ± 4.88); (c) the range of knee flexion was smaller than in group A vs. group B (119.0 ± 10.7 vs 125.5 ± 11.0 degrees); (d) there was no significant difference between the mean of range of knee extension between the two groups groups; (e) in terms pain referred by the patient, no difference was observed according to VAS pain. CONCLUSION: Patellar denervation does not show better effect in pain reduction compared with TKA with non-patellar denervation. However, it had a better beneficial effect on knee function score, as measured through the KSS and WOMAC questionnaires. This procedure has become quite common, especially in the last two decades due to the aging of population and to the growing number of obese people. 2,3One of the most common problems during the postoperative period of this procedure is the incidence of anterior knee pain (AKP). About 10 to 15% of patients undergoing surgery will show these symptoms. It is noteworthy that the presence of pain is of utmost importance when evaluating the results of TKA, because patient satisfaction is linked to its presence or absence during the postoperative period. 4,5 Some authors assign the AKP to the distribution of nerve fibers and P-substance in soft tissues around the knee, suggesting a relation with hyper-innervation of peripatellar soft tissues. Therefore, disabling these nerve fibers by electrocautery could, in theory, achieve a satisfactory level of denervation and, consequently, reduce local pain. 1,6 Studies have shown a positive effect of patellar denervation in reducing the incidence of AKP. 7,8 A recent meta-analysis demonstrated that patellar denervation
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