Title Periprotetička infekcija nakon ugradnje totalne endoproteze kuka Title (english) Periprosthetic infection following hip arthroplasty Author Ivana Vukadin Mentor Zrinka Bošnjak (mentor) Committee member Ana Budimir (predsjednik povjerenstva)Committee member Goran Tešović (član povjerenstva)Committee member Zrinka Bošnjak (član povjerenstva) Granter University of Zagreb Defense date and country 2023-09-28, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Totalna endoproteza kuka je čest postupak u ortopediji kojim se odstranjuje oštećena
kost i hrskavica koja se zamjenjuje protetskim komponentama. Totalna endoproteza kuka koju
obavlja iskusni kirurški tim daje vrlo učinkovite rezultate, pružajući olakšanje boli,
funkcionalnu obnovu i poboljšanu kvalitetu života no treba biti svjestan mogućih komplikacija
postupka. Jedna od čestih komplikacija nakon ugradnje totalne endoproteze kuka je infekcija.
Za uspješno liječenje osnovne infekcije uz očuvanje funkcije zgloba, liječenje mora sadržavati
učinkovitu dijagnozu i liječenje prilagođeno pacijentu na temelju algoritma i interdisciplinarne
suradnje. Klinička, laboratorijska i standardna radiološka pretraga zlatni su standard za
dijagnosticiranje infekcije. Temelj optimalnog kirurškog liječenja je precizan debridman s
uklanjanjem svih devitaliziranih materijala i stranih tijela koja sadrže zreli biofilm. Standardni
postupak kod akutne infekcije je debridman, irigacija, promjena pokretnih dijelova i retencija
proteze. Kod kroničnih infekcija, pacijenata s intaktnim ili blago oštećenim mekim tkivom i
mikroorganizmima koji se lako liječe, potpuna zamjena proteze u jednoj fazi je tretman izbora.
Ovaj je postupak povezan s manjim morbiditetom i boljim funkcionalnim ishodom bez značajne
razlike u stopi izlječenja u usporedbi s revizijama u više faza. Sadašnji koncept antimikrobnog
liječenja uključuje 12 tjedana terapije. Za postizanje najboljeg mogućeg ishoda nužan je
dodatak antibiotika koji djeluju na biofilm. Kako bi se spriječila pojava antimikrobne
rezistencije, ove antibiotike treba koristiti kao ciljanu terapiju i dodati ih tek nakon ponovne
ugradnje proteze.
Liječenje infekcije protetskog zgloba najbolje obavlja multidisciplinarni tim koji se
sastoji od ortopeda, kliničkog mikrobiologa, infektologa, fizioterapeuta te medicinske sestre.
Ovi pacijenti često ostaju vezani za krevet dulje vrijeme, pa se stoga preporučuje fizikalna
terapija s vježbama za zglobove i treniranje mišića. Savjetovanje o prehrani može pomoći u
sprječavanju gubitka mišića, a medicinska sestra treba osigurati da pacijent ima profilaksu
protiv duboke venske tromboze i dekubitusa. Nakon otpusta, većina pacijenata treba aktivnu
fizikalnu terapiju mjesecima kako bi povratili pokretljivost zglobova i snagu mišića.
Abstract (english) Total hip replacement is a common procedure in orthopedics that removes damaged
bone and cartilage and replaces it with prosthetic components. Total hip arthroplasty performed
by an experienced surgical team gives very effective results, providing pain relief, functional
restoration and improved quality of life, but one should be aware of the possible complications
of the procedure. One of the frequent complications after the installation of a total hip
endoprosthesis is infection. To successfully treat the underlying infection while preserving joint
function, treatment must include effective diagnosis and patient-tailored treatment based on an
algorithm and interdisciplinary collaboration. Clinical, laboratory and standard radiological
examinations are the gold standard for diagnosing infection. The basis of optimal surgical
treatment is precise debridement with the removal of all devitalized materials and foreign
bodies containing mature biofilm. The standard procedure for acute infection is debridement,
irrigation, change of movable parts and retention of the prosthesis. In chronic infections,
patients with intact or mildly damaged soft tissue and microorganisms that are easily treated,
complete replacement of the prosthesis in one stage is the treatment of choice. This procedure
is associated with less morbidity and better functional outcome with no significant difference
in cure rate compared with multistage revisions. The current concept of antimicrobial treatment
includes 12 weeks of therapy. To achieve the best possible outcome, the addition of antibiotics
that act on the biofilm is necessary. In order to prevent the emergence of antimicrobial
resistance, these antibiotics should be used as a targeted therapy and added only after reinsertion
of the prosthesis.
The treatment of infection of a prosthetic joint is best performed by a multidisciplinary
team consisting of an orthopedist, a clinical microbiologist, an infectious disease specialist, a
physiotherapist and a nurse. These patients often remain bedridden for long periods of time, so
physical therapy with joint exercises and muscle training is recommended. Dietary counseling
can help prevent muscle wasting, and the nurse should ensure that the patient has prophylaxis
against deep vein thrombosis and pressure ulcers. After discharge, most patients need months
of active physical therapy to regain joint mobility and muscle strength.
Keywords
periprotetička infekcija
ugradnja totalne endoproteze kuka
degenerativne bolesti kuka
liječenje periprotetičke infekcije
rehabilitacija.
Keywords (english)
periprosthetic infection
total hip arthtoplastic
degenerative hip diseases
treatment of periprosthetic infection
rehabilitation
Language croatian URN:NBN urn:nbn:hr:105:594852 Study programme Title: Studies in Nursing Type of resource Text File origin Born digital Access conditions Open access Terms of use Created on 2024-04-18 11:49:55
