Philip Mark Anderson MD , Thiemo Frank , Michaela Herz MD , Oliver Kurzai MD , Maximilian Rudert MD , Tizian Heinz MD , Thiên-Trí Lâm MD
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引用次数: 0
Abstract
Background
With the rising prevalence of obesity, surgeons are frequently confronted with the problem of treating osteoarthritis of the hip via arthroplasty (total hip arthroplasty) in severely obese patients. To reduce the surgical impact, minimal-invasive approaches are often chosen. For this reason, the direct anterior approach has gained popularity but is suspected of leading to more wound complications in obese patients, especially by Gram-negative pathogens. Causative differences of the skin microbiome have been suspected but not yet proven.
Methods
Patients scheduled for total hip arthroplasty via direct anterior approach were screened for inclusion. The study group was defined as patients with a body mass index ≥35 and an abdominal pannus hanging over the incision site, whereas nonobese patients served as the control group. Samples of the microbiome were taken 2-3 cm distal and lateral to the superior anterior iliac spine using plates and swabs. Species identification was carried out by mass spectrometric analysis.
Results
The study group consisted of 28 patients, the control group of 36 patients. The most frequent potential pathogen on the skin was Staphylococcus epidermidis in both the groups. Microbiota found in obese patients showed significantly higher prevalence of Gram-negative bacteria from the order Enterobacterales. Wound complications were more frequent in the study group, but this was not statistically significant.
Conclusions
Obese patients with abdominal pannus present higher rates of colonization with Enterobacterales at the incision site of the direct anterior approach. Modifications of the antibiotic regime and the incision should be considered in this special patient population.
期刊介绍:
Arthroplasty Today is a companion journal to the Journal of Arthroplasty. The journal Arthroplasty Today brings together the clinical and scientific foundations for joint replacement of the hip and knee in an open-access, online format. Arthroplasty Today solicits manuscripts of the highest quality from all areas of scientific endeavor that relate to joint replacement or the treatment of its complications, including those dealing with patient outcomes, economic and policy issues, prosthetic design, biomechanics, biomaterials, and biologic response to arthroplasty. The journal focuses on case reports. It is the purpose of Arthroplasty Today to present material to practicing orthopaedic surgeons that will keep them abreast of developments in the field, prove useful in the care of patients, and aid in understanding the scientific foundation of this subspecialty area of joint replacement. The international members of the Editorial Board provide a worldwide perspective for the journal''s area of interest. Their participation ensures that each issue of Arthroplasty Today provides the reader with timely, peer-reviewed articles of the highest quality.