Total knee and hip arthroplasty: the reality of assistance in Brazilian public health care

Ferreira, Marcio de Castro; Oliveira, Julio Cesar Pinto; Zidan, Flavio Ferreira; Franciozi, Carlos Eduardo da Silveira; Luzo, Marcus Vinícius Malheiros; Abdalla, René Jorge

doi:10.1016/j.rboe.2018.05.002

Cited by 22 publications

(35 citation statements)

References 19 publications

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“…The study also found a higher frequency of infection in patients with associated diseases, hospital stay of more than 6 days, surgical time of between 2 and 3 hours, use of prophylactic antibiotics and in patients classified as type II in the classification of ASAPS. However, in this study the results were not significant for hospital stays higher or lower than 5 days, and the other variables studied (duration of surgery, associated comorbidities, use of prophylactic antibiotic, ASAPS classification, side of operated knee, age and length of hospital stay) were also not significant and determinant factors for increased prevalence of infection, contrasting with other studies [2]- [12] [14]- [21].…”

Section: Discussioncontrasting

confidence: 99%

“…A small proportion of individuals diagnosed with arthroplasty infection maintained the result of negative culture and required empirical therapy, corroborating with other authors [10] [11] [12] [13] [14]. In this study the negative P. C. V. C. was also observed in patients of this present study and in these cases it is necessary to remove the implants [7]- [14].…”

Section: Discussionsupporting

confidence: 91%

“…In the present research study, the infection diagnosis of the surgical site obeyed the clinical, laboratory and imaging exam criteria already adopted by ANVISA, NHSN and Guiline of AAOS-and already used in other publications [1]- [6] [10] [12] [14]- [21].…”

Section: Discussionmentioning

confidence: 99%

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Risk of Surgical Site Infection in Patients Undergoing Total Knee Arthroplasty

Albuquerque¹,

Ferraz²,

Olbertz³

et al. 2018

OJO

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The aim of this study was to determine the participation of risk factors in the infection in patients who underwent total knee arthroplasty. This is a prospective longitudinal study, descriptive and analytical, that was carried out between January 2013 and December 2015. Eighty-one procedures were performed in 78 individuals, 16 males and 62 females. Three subjects underwent the procedure on both knees. The following predictive factors of infection were identified: Age, gender, comorbidities, evaluation of functional physical status using the American Society of Anesthesiologists Physical Status Classification System (ASAPS), length of hospital stay, use of prophylactic antibiotics and duration of surgery. The data was tabulated in a database using a Microsoft Excel spreadsheet. For statistical analysis, the chi-square test, chi-square test for independence and Fischer's exact test were applied, all at a significance level of 5% (0.05). Surgical site infection was more prevalent in males (23.5%), age over 70 years (25.0%), for left gonarthrosis (17.9%), in the presence of comorbidities (17.9%), when hospital stay was 6 or more days (27.8%), in total arthroplasties of left knee (17,9%), in surgical times of up to 2 hours (20%), in the use of prophylactic antibiotics (16.7%) and in level II classification in the ASAPS (18.8%). The independence test was not significant in any of the evaluated factors (p-value greater than 0.05). The most prevalent bacteria identified in cases of infection was Staphylococcus aureus (33.2%). The risk factors studied were not statistically significant.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionsupporting

confidence: 91%

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Risk of Surgical Site Infection in Patients Undergoing Total Knee Arthroplasty

Albuquerque¹,

Ferraz²,

Olbertz³

et al. 2018

OJO

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“…There is a shortage of Brazilian arthroplasty data in the literature. Ferreira et al [17] showed date on public care but without data about costs. They have shown the reduction in LOS from 2008 to 2015 in Brazil, being the Midwest region of the country with the highest average of reduction (6.6 days), showing the heterogeneity of health care system in that country.…”

Section: Plos Onementioning

confidence: 99%

Clinical pathway improves medical practice in total knee arthroplasty

et al. 2020

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Clinical pathways in total knee arthroplasty (TKA) consist of general guidelines, including several topics as early rehabilitation and antibiotic systematization, which are used to improve patient's management, decrease complication rates and enhance clinical outcomes. The primary purpose of this study was to assess whether the use of a clinical pathway for TKA can contribute to reduce LOS and healthcare costs in a private hospital, without an increase in the hospital readmission rate. We also aimed to assess whether care providers adhered to the recommendations mainly antibiotic use and physical therapy. Methods Retrospective cohort study of 485 patients who underwent TKA at private hospital. Patients were analyzed in two groups: Group I (GI), composed by 220 TKA patients, prior to the clinical pathway implementation, and Group 2 (GII), with 265 TKA patients post-clinical pathway. Several outcomes were analyzed: length of hospital stay, time from use of prophylactic antibiotic therapy, readmission within 30 days, physical therapy and costs associated to procedures and hospitalization rates. Results The implementation of the clinical pathway was related with the reduction of the length of hospital stay from 6.3 days to 4.9 days (p = 0.021) without increase in readmissions. The physical therapy on the first postoperative day was most frequent in GII than GI (96.2% vs 78.1%, p < 0.001). Prophylactic ATB 60 minutes prior the surgery was significantly more used in GII than GI (99.2% vs 87.4%, p < 0.001). In addition, ATB suspension within 48 hours was significantly more frequent in GII than GI (84.7% vs. 51.6%, p < 0.001). The cost procedure of TKA showed a reduction of US$1,252.00 in GII when compared with GI (p<0,001).

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“…1,2 A ATJ pode ser definida como um procedimento cirúrgico de alta complexidade para o tratamento da artrose capaz de demonstrar dados satisfatórios e duradouros na melhora da dor, da qualidade de vida, e da função do paciente, bem como na correção de deformidades e instabilidades de origens relacionadas a processos degenerativos que comprometem a articulação do joelho. 3 Este procedimento apresenta excelentes resultados pós-operatórios em relação à sobrevida do implante, com índices de mais de 95% em pelo menos 10 anos de seguimento. 4 O desgaste do polietileno pode produzir detritos que influenciam na soltura dos componentes protéticos.…”

Section: Introductionunclassified

Avaliação do desgaste do polietileno de uma prótese de joelho nacional ultracongruente de base rotatória

Pécora

Romero

2020

Rev Bras Ortop (Sao Paulo)

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Resumo Objetivo Avaliar o desgaste do polietileno de uma prótese de joelho brasileira ultracongruente de base rotatória (Rotaflex, Víncula, Rio Claro, SP, Brasil). Métodos Utilizou-se o método de ensaio com os parâmetros de carregamento e preparação citados na norma ISO 14243-1:2009, e os métodos de medição citados na norma ISO 14243-2:2009, para a avaliação do comportamento de desgaste de uma prótese nacional com base rotatória. O equipamento utilizado para o teste de desgaste foi o simulador de marcha ISO 14243–1 (EndoLab, Riedering, Alemanha). Resultados Após 10 milhões de ciclos, a avaliação do desgaste do polietileno mostrou uma aparência regular do desgaste da superfície com taxa média de 2,56 mg por milhão de ciclos. Conclusão O desgaste do polietileno da prótese avaliada foi mínimo após os ensaios realizados e com os limites de segurança superiores aos preconizados pela engenharia biomecânica.

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Total knee and hip arthroplasty: the reality of assistance in Brazilian public health care

Cited by 22 publications

References 19 publications

Risk of Surgical Site Infection in Patients Undergoing Total Knee Arthroplasty

Risk of Surgical Site Infection in Patients Undergoing Total Knee Arthroplasty

Clinical pathway improves medical practice in total knee arthroplasty

Avaliação do desgaste do polietileno de uma prótese de joelho nacional ultracongruente de base rotatória

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