Caracterização de artroplastias de quadril e joelho e fatores associados à infecção

Multiple deep tissue cultures in primary total hip arthroplasty: prognostic value for periprosthetic infection

BACKGROUND

The risk of infection after total hip replacement (THR) is significant, with negative impact on quality of life and high costs. Bacteria can contaminate the surgical site despite aseptic techniques; however, there is debate regarding the benefit of identifying bacteria during the primary procedure. Although taking multiple samples for culture is a well-established practice in revision arthroplasty, doing so in primary cases remains controversial. We aimed to investigate whether there is a prognostic value in the culture of samples taken during primary THR, seeking a correlation between the positivity of the cultures and subsequent prosthetic joint infection (PJI).

METHODS

Deep samples (capsule, femoral and acetabular bone) were collected from 426 patients undergoing elective primary THR. Follow-up was at least 3 years. Microbiological profiles of cultures were analysed. Patient data were reviewed for the identification of risk factors presumably associated with a higher risk of PJI.

RESULTS

54 surgeries (12.6%) had positive cultures. 16 cases (3.8%) developed infection, of which 5 had a positive culture in the primary surgery. Infection rate was 9.3% in patients with positive culture and 3% in those with negative culture (p < 0.05), with an odds ratio of 3.34 (95% CI, 1.09-10.24). Patients with previous hip surgery had an infection rate of 8.5%, compared to 2.9% in patients with no previous surgery (p < 0.05).

CONCLUSIONS

Routinely harvesting microbiologic samples in primary THR is not justified, as it has no consequence in clinical decision for most patients. It might be recommended in selected cases that are suspected to be at high risk for infection, especially previously operated patients (conversion arthroplasty).

Evaluation of Surgical Wound Healing in Orthopedic Patients with Impaired Tissue Integrity According to Nursing Outcomes Classification

PURPOSE

To assess the surgical wound (SW) healing in orthopedic patients with Impaired tissue integrity according to the Nursing Outcomes Classification (NOC).

METHODS

A prospective longitudinal study performed with 24 patients. Data collection was performed through an instrument containing the NOC indicators.

FINDINGS

The indicators skin approximation, drainage, surrounding skin erythema, periwound edema, increased skin temperature, and foul wound odor presented a statistically significant increase when compared the means between the first and the last day of evaluation.

CONCLUSION

The NOC indicators allowed to monitor the SW healing indicating an improvement.

IMPLICATIONS FOR NURSING PRACTICE

The NOC can favor an earlier identification of the degree of commitment for each patient and enables implementation of care to achieve target outcomes.

CLINICAL DEMOGRAPHIC CHARACTERISTICS OF TOTAL KNEE ARTHROPLASTY IN A UNIVERSITY HOSPITAL

OBJECTIVE

To assess socio-demographic characteristics of patients undergoing total knee arthroplasty (TKA) in a public university hospital, evaluating the outcome infection and associated factors.

METHOD

A retrospective study was carried out with 78 patients undergoing TKA, from 2013 to 2014. The socio-demographic and clinical characteristics of the patients were collected. Comparison between infected and non-infected patients was performed to find out which variables were possibly associated to this complication.

RESULT

Of 81 arthroplasties performed, patients were older (mean age 64 years), women (79%), with primary osteoarthritis as main etiology (87.6%) and most had comorbidities (82.7%). Infection occurred in 16% of patients, and this outcome associated with age older than 65 years (p=0.023) and the occurrence of deep vein thrombosis (p=0.027).

CONCLUSION

Patients undergoing TKA are mostly elderly women with primary osteoarthritis in the knee and comorbidities who developed infection in 16% of cases. More studies need to be conducted aimed at creating specific protocols in order to improve the quality of clinical practice. Level of Evidence III, Retrospective Comparative Study.