Comparação funcional entre revisão de artroplastia de joelho séptica e asséptica

Abstract

Infection in TKA is not the most frequent complication, but it is one of the most serious ones. 7 Its incidence ranges from 0.5% to 23%. 8,9 Post-TKA infections represent an economical impact of three hundred million dollars each year in the United States. 10For a knee arthroplasty infection treatment to be successful, early diagnosis and the prompt administration of therapeutic measures are essential; therefore, all patients presenting with postoperative pain should be screened. The most common clinical sign is continuous pain, local heat, and edema, with erythema being infrequent.11 For diagnosing it, the following are necessary: appropriate physical examination, X-ray studies, evidence of inflammatory activity, and, occasionally, tapping the affected knee in case of questionable diagnosis. Therapy for total knee arthroplasty infections is controversial. Approaches include: antibiotic therapy (oral or endovenous), aggressive debridement through arthrotomy or arthroscopy, resection arthroplasty, arthrodesis, one-or two-step review, arthrodesis and amputation.12-14 For the two-step review, the first step is to remove the primary prosthesis with debridement and placing a cement spacer with antibiotics, keeping the patient on endovenous antibiotic therapy for 6-8 weeks, while in the second one, total arthroplasty is reviewed. 15The spacer impregnated with antibiotics plays two primary roles: the first one is the local release of antibiotics, assisting with fighting the infection, while the second is to maintain spaces, reducing soft parts retraction, enabling an easier insertion of a definitive prosthesis. 13,16 ABSTRACT Introduction: Total knee arthroplasty (TKA) imposes many risks. TKA infection is not the most frequent complication, but is probably the most serious one. Two-step review is the procedure of choice in deep knee prosthesis infection. On the other hand, aseptic prosthesis detachment represents almost half of the primary arthroplasty review indications. Patient´s satisfaction level might diminish after reviews. Objective: The objective of this study was to compare the quality of life and final result of TKA review for septic and aseptic failures. Methods: The patients were assessed using the HSS and SF-36 scores. The patients were divided in two groups: one group submitted to two-step review (septic) and the other to one-step review (aseptic). The analysis of the data obtained shows better scores for the second group in HSS and in 06 of 08 domains of SF-36 classification. Conclusions: The on-step review of total knee arthroplasty leads to better functional outcomes.

Infected primary knee arthroplasty: Risk factors for surgical treatment failure

“…Among all the complications, post-arthroplasty infection is one of the most severe and feared types and its incidence may range from 0.5 to 23% 2, 3. Post-arthroplasty knee infections have an economic impact greater than 300 million dollars per year in the countries of North America 4 …”

“…For treatment of infected TKA to be successful, early diagnosis is fundamental, with immediate application of therapeutic measures. Appropriate physical examination, imaging examinations, laboratory tests to investigate inflammatory activity and puncturing of the affected knee may assist greatly in defining the best management 4 …”