Notas / Notes - Active Congress.......

JUEVES / THURSDAY
120
11.15 - 12.00 h
CADERA / HIP
Infecciones / Infections
Moderador: Xavier Flores
THE DIAGNOSIS AND MANAGEMENT OF
PERI-PROSTHETIC INFECTIONS
P McLardy-Smith, B Atkins, H Pandit, T Berendt, N
Athanasou & the Oxford Hip and Knee Group (Richie
Gill, David Beard, Vicky Flanagan, Chris Dodd, Max
Gibbons, Roger Gundle, David Murray, Andrew Price,
Duncan Whitwell)
California (USA)
Total hip replacement is probably the most successful operation
ever devised and other joints, particularly the knee
are now being successfully replaced. However peri-prosthetic
infection remains a potentially catastrophic complication.
Infection rates are reported at between 1- 2% and the risk
of a peri-prosthetic infection runs over the entire life time of
the joint. Peri-prosthetic infections can usefully categorised
as early acute or chronic and late acute or chronic. The
diagnosis of chronic infections, particularly late ones, may
be difficult to achieve pre-operatively. Imaging techniques
and serological testing can be useful but are not as yet
reliable or specific. Aspiration or closed biopsy are similarly
unreliable. Any joint revised for any reason may have an
underlying infection. In a prospective study of 334 consecutive
hip and knee revisions we sent multiple samples from each
case for bacteriological and histological analysis. We used
the histological appearance as the criterion for defining
infection. By this definition 15% of infected cases were culture
negative and one positive culture specimen has no predictive
value for under lying infection. Two or more positive cultures
out of 5 or 6 samples as a useful predictive value.
In acute infections, if the components are soundly fixed,
salvage should be attempted with adequate debridement
sampling and lavage of the joint. Arthroscopic washout in
Staphylococcal knee infections has a very poor outcome.
We would then recommend long term antibiotic therapy.
Salvage maybe possible in chronic infections, but usually
the components are loose within the bone and a full revision
will be required. Frozen section histological analysis of the
tissue at the time of surgery can differentiate septic from
aseptic loosening and maybe relied upon to choose between
a one or a two stage revision.
INFECTED TOTAL HIP ARTHROPLASTY.
ONE STAGE REVISION
B. M. Wroblewski, H. Nagai, P. D. Siney, P. A. Fleming
The John Charnley Research Institute, Wrightington Hospital,
Hall Lane, Appley Bridge Near Wigan (Great Britain)
One of the most serious complications of THA is deep infection.
Charnley realised the problem. This led to the development
of clean air enclosure, total body exhaust suits and the introduction
of the instrument tray system. Subsequently antibiotics
were used both systematically and also as an addition to the
acrylic cement. Occasional deep infection requires further intervention,
either by removing the implant, or performing one
or two stage revision.
It has been the senior author’s practice to undertake one-stage
revision provided the bone stock was of sufficiently good quality
to ensure reasonable quality of component fixation. The technique
is based on the accepted principle of infection management:
Removal of all foreign body material and infected tissues,
application of local antiseptics/antibiotics, closure of cavities,
ensuring stability, drainage, rest, continuation of antibiotics.
Between January 1974 and December 2001, 185 one-stage
revisions were carried out by the senior author: 162 had a
minimum follow-up of 5 years with a mean of 12.3 years (5.1
– 27.6 years). 138 cases (85.2%) were free from infection.
Presence of a sinus at revision did not affect the outcome
adversely – on the contrary - 90.4% were infection free as
compared with 82.7% of those without a sinus.
THE MARSA GHOST
Thorsten Gehrke
Endo-Klinik. Hamburg (Alemania)