Diagnóstico y manejo de la artroplastía de cadera infectada

Abstract

INTRODUCCIONLos reemplazos articulares de caderas enfermas alivian el sufrimiento y restauran la función de miles de personas año tras año.En E.U.A. se realizan 250.000 artroplastías de cadera anualmente. Sin embargo, como todo acto quirúrgico, no están exentas de complicaciones siendo la infección periprotésica sin duda la más temida, tanto por los costos emocionales inherentes al largo proceso de tratamiento a seguir, como por la implicancia económica que ésta tiene. El costo anual que representa el tratamiento de una artroplastía infectada en E.U.A. fue estimado en 1984 entre 40 y 80 millones de dólares. Actualmente se considera que un pa- Rev Chil Infect (2000); 17 (2): 92-100 INFECTOLOGIA AL DIA DIAGNOSIS AND TREATMENT OF HIP PROSTHESIS INFECTIONThe periprosthetic infection that occurs in about 1% of total hip arthroplasties, implies high emotional and economical cost for the patient and for health care systems, respectively. In this article the pathophysiology of this complication and the disposable diagnostic resources are reviewed. Two alternative treatments have been proposed: debridement with prosthesis retention or resection of the arthroplasty (in one or two times). Topical antibiotic benefits used for the prevention of prosthesis infection at total hip arthroplasty are refered.

Comparative of Infection Rate in Non-Elective and Elective Surgery, and Its Relation on Quality of Life

“…Tsukayama classification (used in the study) divides infection into four groups: early postoperative infection (acute onset, usually before 3-4 weeks following surgery), chronic-late postoperative infection (chronic indolent presentation after the first month after surgery), positive intraoperative cultures (microorganisms isolation and / or pus in joint replacement, without infection clinical suspicion) and acute hematogenous infection (hematogenous spread from a distant focus) [1,5,6]. surgical site infection occurrence at long term: frequent urinary tract infections presence, recent tooth extraction (near the time of surgery) and poor dental hygiene.…”

“…Infections are mostly produced by Staphylococcus epidermidis (methicillin resistant in 30% of cases), followed by Staphylococcus aureus infections (5% methicillin resistance). Gram negative bacilli are often observed, highlighting Escherichia coli and Pseudomonas aureoginosa [5][6][7][8].…”