Protocol for Treating Acute Infections in Cases of Total Knee Arthroplasty

Abstract

Objective:To retrospectively evaluate the results after applying a protocol for treating acute infections in cases of total knee arthroplasty and to establish factors predictive of success or failure.Methods:Thirty-two patients who were diagnosed with acute infection of the knee following total arthroplasty between 2004 and 2009 were retrospectively evaluated. Infections following arthroplasty were treated in accordance with the protocol for acute infections following arthroscopy recommended at our institution.Results:With application of a treatment protocol for acute infections following total knee arthroplasty, 26 patients (81.2%) had good results and 6 (18.8%) had unsatisfactory results. Statistical analysis showed that the variables correlated with a worse prognosis were age (p = 0.038) and number of surgical debridement procedures performed (p = 0.038).Conclusion:Our treatment routine was effective for infection. Prosthesis revision was performed in 2 cases when the initial surgical debridement failed to control the infection. Nível de Evidência IV, Série de casos.

Fatores associados ao desenvolvimento de complicações precoces após artroplastia total do joelho

“…4 Dentre as complicações pós-operatórias, as infecções podem ser devastadoras, especialmente as infecções profundas, gerando internações prolongadas e novos procedimentos ou cirurgias de revisão. 5 Além destes, podem ocorrer solturas assépticas, artrofibrose, tromboembolismo venoso e eventos cardiovasculares desencadeados pelo trauma cirúrgico, além dos relacionados à internação hospitalar. 6 …”

“…4 Among the postoperative complications, infections that can be devastating, especially deep infections, causing prolonged hospitalizations and new procedures or revision surgeries. 5 In addition to these, aseptic loosening, arthrofibrosis, venous thromboembolism, and cardiovascular events triggered by surgical trauma can occur, in adition to those leading to hospital admission. 6 Parameters and scores are often used to identify patients at higher risk for complications after surgical treatment, such as the American Society of Anesthesiologists (ASA) score.…”

“…4 Dentre as complicações pós-operatórias, as infecções podem ser devastadoras, especialmente as infecções profundas, gerando internações prolongadas e novos procedimentos ou cirurgias de revisão. 5 Além destes, podem ocorrer solturas assépticas, artrofibrose, tromboembolismo venoso e eventos cardiovasculares desencadeados pelo trauma cirúrgico, além dos relacionados à internação hospitalar. 6 Frequentemente, são utilizados parâmetros e escores para identificar os pacientes de maior risco para ocorrência de complicações após o tratamento cirúrgico, como o escore da Sociedade Americana de Anestesiologistas (ASA, na sigla em inglês).…”

The economic impact of periprosthetic infection in total knee arthroplasty

“…Currently, 2-stage revision surgery remains the gold standard for treating PJI in most centres. 6,7 Revision TKA is a complex procedure that usually requires a specialized arthroplasty surgeon prepared to handle complex cases and revision instruments that are typically available in tertiary care centres. 8 It has been reported that the cost of treatment of infection after TKA is at least 3 times that of primary TKA and twice that for aseptic knee revision.…”