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The Archives of Bone and Joint Surgery، جلد ۹، شماره ۳، صفحات ۲۴۹-۲۵۴
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عنوان انگلیسی Late Acute Hematogenous Infections after Total Knee Arthroplasty: Results of Debridement, Antibiotics, and Implant Retention
چکیده انگلیسی مقاله The frequency of late acute hematogenous infection (LAHI) following total knee arthroplasty (TKA) is between 0.2%and 0.5%. There is controversy over the results of patients treated for LAHIs by surgical debridement, antibiotics, andimplant retention (DAIR). This narrative review of the literature aims to establish the role of DAIR in LAHIs after TKA.The published success rate (retention of the prosthesis) after DAIR is between 50% and 100%. The success rate isassociated with a shorter duration of symptoms (5–14 days from the onset of symptoms). Factors associated withfailure are an accompanying infection and the diagnosis of rheumatoid arthritis before the TKA is performed. It is notrecommended to indicate a DAIR in patients with atrial fibrillation, chronic obstructive pulmonary disease, the presenceof >15 cells per high-powered field, preoperative C-reactive protein >500 mg/L or methicillin-resistant S. aureus. Insuch patients, a two-stage revision arthroplasty should be recommended. Arthroscopic DAIR has a limited effect. It ismost efficacious in the very early stage of acute presentations of infected TKA. It can be useful in patients with extremefrailty as an adjunct to suppressive antibiotic therapy. If carried out, high volumes of fluid should be utilized. Theindications for an open DAIR are the following: duration of clinical signs and symptoms is less than 3 weeks; patientswith a well-fixed implant; no abscess or sinus tract; low-virulence bacteria; elderly patients with multiple comorbidities;and nonimmunocompromised patients. Open DAIR should not be advised in cases with chronic infection (>4 weekspostoperatively, insidious beginning of symptoms).Level of evidence: III
کلیدواژه‌های انگلیسی مقاله acute hematogenous infection, Antibiotics and implant retention, Debridement, Total knee arthroplasty
نویسندگان مقاله | E. Carlos RODRIGUEZ-MERCHAN
Department of Orthopedic Surgery, La Paz University Hospital, Madrid, Spain
نشانی اینترنتی https://abjs.mums.ac.ir/article_16548.html
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زبان مقاله منتشر شده en
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نوع مقاله منتشر شده CURRENT CONCEPTS REVIEW
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