Введение

medecol

Медицина и экология

Medicine and ecology

2305-60452305-6053

Карагандинский медицинский университет

10.59598/ME-2305-6045-2024-111-2-93-104

medecol-692

Research Article

НАБЛЮДЕНИЯ ИЗ ПРАКТИКИ

CLINICAL CASES

Перипротезная инфекция сустава после тотального эндопротезирования коленного сустава. Извлеченные уроки: клинический случай и обзор литературы

Periprosthetic joint infection after total knee arthroplasty. Lessons learned: a case report and literature review

Конкаев

А.

Konkayev

Айдос Конкаев

010000, г. Астана, пр. Абылай хана, 15А

010000, г. Астана, ул. Бейбитшилик, 49а

Aidos Konkayev

010000, Astana, Abylai-khan avenue, 15A

010000, Astana, Beibitshilik str., 49A

konkaev@mail.ru

Азимова

Б.

Azimova

010000, г. Астана, пр. Абылай хана, 15А

010000, г. Астана, ул. Бейбитшилик, 49а

010000, Astana, Abylai-khan avenue, 15A

010000, Astana, Beibitshilik str., 49A

info@nscto.kz

Кадралинова

А.

Kadralinova

010000, г. Астана, пр. Абылай хана, 15А

010000, г. Астана, ул. Бейбитшилик, 49а

010000, Astana, Abylai-khan avenue, 15A

010000, Astana, Beibitshilik str., 49A

info@nscto.kz

Елтаева

А.

Yeltayeva

010000, г. Астана, пр. Абылай хана, 15А

010000, г. Астана, ул. Бейбитшилик, 49а

010000, Astana, Abylai-khan avenue, 15A

010000, Astana, Beibitshilik str., 49A

info@nscto.kz

Жанарыстан

Н.

Zhanarystan

010000, г. Астана, ул. Бейбитшилик, 49а

010000, Astana, Beibitshilik str., 49A

rektorat@amu.kz

Конкаева

М.

Konkayeva

010000, г. Астана, пр. Абылай хана, 15А

010000, г. Астана, ул. Бейбитшилик, 49а

010000, Astana, Abylai-khan avenue, 15A

010000, Astana, Beibitshilik str., 49A

info@nscto.kz

Отделение анестезиологии, реанимации и интенсивной терапии Национального научного центра травматологии и ортопедии им. академика Н. Д. Батпенова; Кафедра анестезиологии и интенсивной терапии №1 НАО «Медицинский университет Астана»КазахстанDepartment of Anesthesiology and Intensive Care, National Scientific Center of Traumatology and Orthopedics named after Academician N. D. Batpenov; Department of Anesthesiology and Intensive Care №1, NС JSC «Astana Medical University»Kazakhstan

Кафедра анестезиологии и интенсивной терапии №1 НАО «Медицинский университет Астана»КазахстанDepartment of Anesthesiology and Intensive Care №1, NС JSC «Astana Medical University»Kazakhstan

Отделение анестезиологии, реанимации и интенсивной терапии Национального научного центра травматологии и ортопедии им. академика Н. Д. Батпенова; Кафедра инфекционных болезней и клинической эпидемиологии НАО «Медицинский университет Астана»КазахстанDepartment of Anesthesiology and Intensive Care, National Scientific Center of Traumatology and Orthopedics named after Academician N. D. Batpenov; Department of Infectious Diseases and Clinical Epidemiology, NС JSC «Astana Medical University»Kazakhstan

2024

30072024

0293104

2024

Конкаев А., Азимова Б., Кадралинова А., Елтаева А., Жанарыстан Н., Конкаева М.

Konkayev A., Azimova B., Kadralinova A., Yeltayeva A., Zhanarystan N., Konkayeva M.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://medecol.qmu.kz/jour/article/view/692

Введение

Введение. Увеличение доли стареющего населения, людей с избыточным весом и различными проблемами суставов приводит к увеличению спроса на замену суставов. Поскольку число операций по артропластике суставов продолжает расти, постоянная заболеваемость перипротезными инфекциями суставов подчеркивает необходимость комплексного и развивающегося подхода. Помимо предоперационного периода необходимо учитывать также течение интраоперационного периода, и в большей степени послеоперационного периода, когда происходит развитие перипротезной инфекции. Данный случай свидетельствует о том, что недооценка значения послеоперационного периода и контроля факторов риска может привести к инфекции. Это негативно влияет на экономику из-за роста случаев инвалидазации.

Клинический случай

Клинический случай. У пациентки 60 лет после тотального эндопротезирования коленного сустава диагностирована перипротезная инфекция сустава. Преморбидный фон больной отягощался наличием сахарного диабета 2 типа, артериальной гипертензии, вторичной кардиомиопатии, хронической железодефицитной анемии. Одномоментная ревизия эндопротезирования коленного сустава, удаление компонентов протеза, иссечение дегенеративных тканей, длительная антибиотикотерапия, а также реабилитация оказались неэффективными, болевой синдром усилился. В связи с этим пациент госпитализирован на двухэтапную ревизионную операцию, удаление эндопротеза и установку неартикулирующего цементного спейсера с антибиотиком левого коленного сустава.

Заключение

Заключение. На основании соответствующего поиска литературы мы полагаем, что некорригированная хроническая железодефицитная анемия в сочетании с неконтролируемым сахарным диабетом как в предоперационном, так и в послеоперационном периоде эндопротезирования суставов может повышать риск развития перипротезной инфекции. Более того, акцентирование внимания пациентов на важности послеоперационного периода и строгий контроль показателей здоровья помогут снизить вероятность повторного протезирования.

Introduction

Introduction. The increasing proportion of the aging population and overweight people with various joint problems leads to an increased demand for joint replacements. As the number of joint arthroplasty surgeries continues to rise, the persistent incidence of periprosthetic joint infections highlights the need for a comprehensive and evolving approach. In addition to the preoperative period, it is also necessary to consider the course of the intraoperative, and to a greater extent the postoperative period, when the development of periprosthetic infection occurs. This case is indicative of the fact that underestimation of the importance of the postoperative period and control of risk factors can lead to the recurrence of infection. This negatively affects the economy due to an increase in the number of disabilities.

Case presentation

Case presentation. A 60-year-old female patient was diagnosed with a periprosthetic joint infection following total knee arthroplasty. The patient's premorbid background was aggravated by the presence of type 2 diabetes mellitus, arterial hypertension, secondary cardiomyopathy, and chronic iron-deficiency anemia. Single stage revision of knee arthroplasty, removal of prosthetic components, excision of degenerative tissue, prolonged antibiotic therapy as well as rehabilitation were ineffective, and the pain increased. Therefore, the patient is admitted for the two-stage revision surgery, removal of the endoprosthesis, and installation of a nonarticulating cement spacer of the left knee joint.

Conclusion

Conclusion. Through a relevant literature search, we believe that uncorrected chronic iron-deficiency anemia in combination with uncontrolled diabetes mellitus, both in the preoperative and postoperative period for joint replacement, may increase the risk of the development of periprosthetic infection. Moreover, focusing patients' attention on the importance of the postoperative period and strict monitoring of health indicators will help reduce the likelihood of re-prosthetics.

перипротезная инфекция суставатотальное эндопротезирование коленного суставапериоперационная анемияфакторы рискаклинический случай

periprosthetic joint infectiontotal knee arthroplastyperioperative anemiarisk factorsa case report

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The authors declare that there are no conflicts of interest present.