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The effect of gentamicin in irrigating solutions on articular infection prophylaxis during arthroscopic ACLR .A prospective randomized study.

امتیاز کاربران
ضعیفعالی 

 

 

The effect of gentamicin in irrigating solutions on articular infection prophylaxis during arthroscopic ACLR  .A prospective randomized study.

 Abstract

Purpose: The purpose of this study was to investigate whether gentamicin irrigation solutions provide a potential new tool to prevent joint infection after arthroscopic ACL reconstruction.

Methods:  In this prospective study, 360 consecutive ACL recondition patients were randomized in 2 groups alternately from Feb, 2008 to March, 2012. In the first group, 180 patients underwent ACL reconstruction with a hamstring autograft, preoperative IV antibiotics, and normal saline (0.9% sodium chloride) solution.

In the second group 180 patients underwent ACL reconstruction with a hamstring autograft, preoperative IV antibiotics, and normal saline (0.9% sodium chloride solution) with added gentamicin (80mg/L) (group 2). Three patients from group 1 and six patients from group 2 were excluded from the study due to loss of follow-up. The patients were followed for 6 months and assessed for signs of deep infection.

Results: In group 1, a total of 4 (2.2%) postoperative septic arthritis cases were documented,. In group 2, just one postoperative deep infection (septic arthritis) was documented (0.57%). Although the rate of septic arthritis in group 1 was higher than in group 2, statistical analysis showed that the difference between using the gentamicin irrigation solution (80mg/L) and the saline solution alone was not significant.

Conclusions: Using gentamicin in irrigating solutions during arthroscopic ACL reconstruction surgery does not statistically decrease post operation septic arthritis.

Level of evidence: Therapeutic Level II

Key words: ACL reconstruction; septic arthritis; gentamicin; irrigating solution

 

Introduction

 Injury to the anterior cruciate ligament (ACL) is the most common ligament injury in the knee and results in 50,000 to 105,000 reconstructions per year in the United States (1, 2). Arthroscopic anterior cruciate ligament (ACL) reconstruction is an effective method of restoring stability to the knee after ACL rupture. Postoperative septic arthritis is an uncommon (range, 0.14 to 1.7%) but potentially serious complication (3, 4). Despite the low incidence of septic arthritis, it is important to recognize and treat it without delay because of its devastating consequences, such as loss of hyaline cartilage and arthrofibrosis (5, 6).

Prophylactic antibiotic irrigation solutions are used commonly during some orthopedic surgeries, however scientific data regarding their efficacy are inconclusive (7, 8). To our knowledge, there is no article about the prophylactic effect of antibiotic solutions in arthroscopic surgeries until now.

Gentamicin is a cost-effective antibiotic for intraoperative lavage. It has a safety profile, despite its lack of proven efficacy. It is active against a wide range of human bacterial infections, mostly gram-negative bacteria such as pseudomonas and gram-positive bacteria like staphylococcus (9, 10).

The purpose of this study was to investigate whether gentamicin irrigation solutions provide a potential new tool to prevent joint infection after arthroscopic ACL reconstruction. In this study, gentamicin was used in irrigating solutions during arthroscopic ACL reconstruction surgery as an infection prophylactic technique in conjunction with preoperative intravenous (IV) antibiotics.

The hypothesis was that gentamicin irrigation solutions during arthroscopic ACL reconstruction would reduce the postoperative infection rate.

 

METHODS

This is a prospective, randomized trial comparing the use of gentamicin added to saline solution versus simple saline solution during arthroscopic ACL reconstruction in 360 consecutive patients. This study was conducted over a 4-year period (Feb., 2008 to March, 2012).

All participants gave written informed consent for inclusion in the study. The study protocol was approved by the local Medical Ethics Committee.

Based on a power analysis (power ratio=0.26), three hundred and sixty patients were randomized according to their hospital admission number into 2 groups alternately. Three patients from group 1 and 6 patients from group 2 were excluded from the study due to loss of follow-up.

Both groups were similar with regard to age and sex (Table 1). All patients were screened preoperatively for skin scratches, lesions, and local or far infections, and if any were present, surgery was delayed until the lesion or infection improved.

Patients who required a simultaneous partial meniscectomy were included in the study, however patients who had a history of chronic infection near the same knee, those who had previously undergone revision ACL reconstruction, simultaneous osteotomy, meniscal repair, cartilage reconstruction, or other knee ligament reconstructions or those who had open procedures were excluded. Patients with IV drug addiction, alcoholism, steroid use, diabetes or immune deficiency were also excluded.

All surgeries were done by a senior surgeon (HRY) and the same preparation, draping, equipment, and surgical technique were used. Preoperative IV antibiotics were administered to all patients. The protocol of our university hospital is cephazolin (1g) approximately 30 minutes before incision, however vancomcin (1g) or clindamycin (600mg) is considered for patients with documented allergies to cephalosporins .No allergy to cephalosporins was detected and all patients received cephazolin (1g) before surgery.

In both groups a quadrupled gracilis–semitendinosus hamstring tendon autograft was used for reconstruction.

After preparation and draping and with tourniquet control, the tendons were harvested with one longitudinal incision. An arthroscopic examination was done with two standard arthroscopic portals, and anatomic reconstruction using the transportal technique was performed for all patients.

In every case, a button (Flipptack, Karl Storz, Tuttlingen, Germany) was used for femoral fixation, and a bioabsorbable screw (Megafix screw, Karl Storz, Tuttlingen, Germany) was used on the tibial side.

In group 1 normal saline (0.9% sodium chloride) in 3-liter bags with no additives was used for irrigation, but in group 2, gentamicin (80 mg/L) was added to the normal saline solution (240 mg in 3-liter bags) under sterile conditions. The reported minimum effective irrigating dose of gentamicin in is 50 mg/L (11) in English literature  , so 80mg/L was considered to be effective. Routinely, 3 to 4 liters was used for irrigation in each surgery. Operation times were 45 to 70 minutes for both groups.  

Postoperative antibiotics (cephazolin 1gr q6h) were administered for 24 hours. Our protocol for antibiotic prophylaxis after surgery was based on ASHP Therapeutic Guidelines (Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery, 2013) and SIGN guideline 104 (Scottish intercollegiate guidelines network– Antibiotic prophylaxis in surgery, July 2008). Intra–articular drains were used for 24 hours. 

Postoperatively, patients were visited at an orthopedic clinic by the senior surgeon (HRY) at weeks 1, 3, 6, 12, and 24. All patients received the same postoperative rehabilitation program and were advised to notify the surgeon if they had joint effusion, increased pain, limited ROM, swelling, or fever at any time during this period. Patients who could not follow the protocol exactly in the 6-month follow-up or did not want to continue were excluded from the study.

Patients who experienced fever, swelling, severe knee pain or effusion, tenderness, or abrupt restricted motion in the knee were admitted to the hospital. In these suspicious patients, white blood cell count (WBC) with differentiation, C-reactive protein (CRP) titer, and erythrocyte sedimentation rate (ESR) were checked, and the involved knees of all these patients were aspirated. Aspirates were sent to the laboratory for WBC counts, biochemistry, cultures, and antibiotic sensitivity analysis.

Postoperative intra-articular infection was defined as a positive culture (incubated up to two weeks) from a knee aspiration or tissue biopsy or a cell count consistent with intra-articular infection (>10,000 cells/µL) in patients who presented with symptoms consistent with septic arthritis (3,6).

Statistical analysis of the study population was carried out using the X 2 test with Yates correction and the Fisher exact test. A p value of less than 0.05 was considered statistically significant.

 

RESULTS

A total of five (1.4%) postoperative septic arthritis cases were documented. In group 1 (Table 2), a total of four (2.2%) postoperative septic arthritis cases were documented, presenting between one and eight weeks after surgery.

All four infections were acute (stages 1 and 2 of the Gaechter classification) (12) and presented in a follow-up visit. All infected cases were men with a mean age of 25.5 years (range 21 to 31 years) at the time of surgery. All patients presented with sudden knee pain, effusion, and abrupt restricted range of motion. Two of the four patients had low fevers. One patient suffered from high fever and chills.

At first the knees were aseptically aspirated and blood sample was sent for WBC counts and ESR and CRP measuring (Table 2). Every patient underwent immediate arthroscopic irrigation and lavage .In all cases synovial tissue biopsy was sent for aerobic and anaerobic cultures.

In all cases, the autogenous ACL graft appeared intact, so were retained. All patients were immediately started on intravenous empirical antibiotics (cephazolin and gentamicin) after operation. Antibiotic therapy was adjusted according to clinical responses and culture results. IV antibiotic therapy continued for 1-2 weeks until the CRP titer started to decrease.

Then patients were switched to oral antibiotic therapy for an additional two weeks. Knee ROM and rehabilitation exercises were initiated as soon as the patient could tolerate them to prevent arthrofibrosis.

All infections were successfully eradicated .After the 3-month follow-up; all patients had full ROM, good stability, and no recurrent infection.

In group 2, just one postoperative deep infection (stage 3 of the Gaechter classification) was documented (0.57%). It was initiated four weeks after surgery, but the patient was referred to our clinic after an 18-day delay due to a missed diagnosis by another physician. The patient was a young man (27 years old).

He presented with knee pain, effusion, and limited range of motion, but no fever. He had received a period of oral antibiotics. In the laboratory study, the peripheral white cell count of serum was 11100 / µL with PMN 80%. ESR was markedly elevated (110 mm) and CRP increased moderately (83 mg/L). The aspiration was turbid.

The white blood cell count of the aspiration was 85000/µL and had 98% polymorphonuclear cells. The result of the culture was coagulase-negative, S epidermidis. The bacteria was resistant to penicillin and amoxicillin, but was sensitive to gentamicin, methicillin, and vancomycin.

The patient underwent immediate arthroscopic irrigation and lavage and extensive debridement of the necrotic and inflamed tissues. The ACL graft, endobotton and absorbable screw were removed.  Additional lavage and debridement surgeries were performed 3 times.

IV antibiotic therapy was continued for four weeks until the CRP titer started to decrease. The patient’s hospital stay lasted 30 days. He had limited extension/flexion (0-5-110) and painful ROM, but no recurrent infection.

Although the rate of septic arthritis in group 1 was higher than that of group 2, statistical analysis showed that the difference between using gentamicin (80mg/l) irrigation solution and using saline solution alone was not significant (P =0.4).

 

DISCUSSION

In this clinical study the incidence of septic arthritis was 2.1% in the group that received IV antibiotic prophylaxis only, and in the second group which operated  using  gentamicin (80mg/l) irrigation solution in addition to prophylactic antibiotic the rate of deep infection was 0.57%.According to statistical analysis the difference between using gentamicin (80mg/l) irrigation solution and using saline solution alone was not significant (P =0.4).Considering the results , the hypothesis of  this study was not supported.

Many potential complications have been identified which affect the clinical outcome after ACL reconstruction. Septic arthritis is one of these complications that may have a devastating outcome. Fortunately the incidence of infection after ACLR is low (range, 0.14 to 1.7%) (3, 13 ).

Staphylococcus aureus and coagulase negative staphylococcus, and mainly staphylococcus epidermidis are the most common bacteria found in septic arthritis after ACLR (14, 15). In the present series, three cultures were negative and in two cases, pseudomonas and staphylococcus epidermidis were found in the cultures. Two cases with a negative culture had a history of oral antibiotic therapy by another physician before being referred to our center.

The most common presenting signs were sudden knee pain, effusion, and limited range of motion. Fever was not recognized as a symptom in all patients. In other studies, the most common signs of septic arthritis after ACL reconstruction were effusion and sudden pain (16, 17). Most infections (all but one) were diagnosed in the acute phase. The average time to presentation of symptoms after ACL reconstruction was 24.7days (range 8 to 57 days).

Daniel Judd et al. studied 1610 ACL reconstructions retrospectively. They found 11 deep infections after surgery. In this study, knee effusion, painful range of motion, and fever were more common in the intra-articular infection group. The average time to presentation of symptoms after ACL reconstruction was 14.2 days (range, 6 to 45 days) for the deep infections (3).

Antibiotics selected for surgical prophylaxis should cover microorganisms that predictably cause infection, should be given for a short duration, be free of side effects, be relatively inexpensive, and should not readily lead to an emergency of microbial resistance (18).

There is a general agreement that antibiotic prophylaxis in surgery should not be given for longer than 24 hours, and a single dose of an antibiotic will suffice for surgical procedures that do not exceed 3–4 half-lives of the drug, provided there is no substantial blood loss (19).

In a prospective, observational study, Chow et al. evaluated the emergence of resistance during antibiotic therapy in 129 patients with enterobacter bacteremia. Previous administration of a third generation cephalosporin was more likely than other antimicrobials to be associated with multi-resistant enterobacter isolates in an initial blood culture (p < 0.001).

The emergence of resistance to a third generation cephalosporin was more frequent than to amino-glycosides (p <0.001) (20). According to this study it seems that selecting gentamicin as an antibiotic in irrigating solution is better than third generation cephalosporin.

Toxicity for most antibiotics isn't a great problem if only a single dose is given. Although for drugs with a narrow therapeutic index, like amino-glycosides, adaptation of the dose is necessary in case of renal failure, using it in a lavage solution doesn't have its systemic effects (21).  None of the patients in the present study had renal failure.

 Christopher J. Vertullo et al. studied 1135 hamstring autograft ACL reconstructions. They compared 2 groups of patients who underwent ACL reconstruction with hamstring autografts with presoaking and without presoaking in vancomycin solution. They suggested that the prophylactic vancomycin presoaking of hamstring autografts statistically reduces the rate of infection (22).

Vancomycin mainly affects gram-positive microorganisms, but gentamicin is a broad–spectrum antibiotic that has a good effect on most gram-positive and gram- negative bacteria (23), so gentamycin seem to be better option than vancomycin.

 In 2002 Lescun TB et al. focused on the effects of the continuous intra-articular infusion of gentamicin on the synovial membrane and articular cartilage in the tarsocrural joint of horses. They used a balloon infusion system attached to a catheter placed in the tarsocrural joints of horses for continuous gentamicin solution delivery for 5 days.

They concluded that the continuous 5-day infusion of GM into the tarsocrural joint of horses has no significant effects on the histological scores of articular cartilages or synovial membranes (10). Therefore, in this study, low dose gentamicin (80mg/L) was used for a limited time (45 to 70 minutes) and washed down after surgery to reduce the probability of side effects.

Bortnem KD et al. studied the therapeutic efficacy, cost, and safety of gentamicin lavage solution in orthopedic surgery prophylaxis. They concluded that gentamicin is also a cost-effective antibiotic for intraoperative lavage, but they couldn’t prove its efficacy (9).

Gentamicin lavage solution has been used for many years in open fractures and total joint replacements to decrease the infection rate (9, 10), but no reports exist on adding the antibiotic to the irrigating solution in ACL reconstruction to decrease infection.

Based on the above reasons, gentamicin was used in the current study as a prophylactic antibiotic in irrigating solutions, because it is a broad–spectrum, inexpensive, and available antibiotic. When it is used in irrigating solution it is safe, and its microorganism resistance is less than others, like third generation cephalosporins; however this study did not show that adding gentamicin to irrigating solutions in addition to prophylactic preoperative IV antibiotics statistically reduces the rate of infection after ACLR.

 

Limitations

This study had some potential limitations. It was not a blind study protocol. A further double-blind randomized trial would eliminate this potential bias. A second limitation was the number of cases. Because there was some limitation to have more cases, the power of study was considered to be 0.26.

Because the rate of deep infection after ACLR is very low, the results may change with larger samples and greater power ratio, so a prospective double-blind study with a larger sample base may prevent these potential limitations.

 

CONCLUSIONS

Using gentamicin in irrigating solutions during arthroscopic ACL reconstruction surgery did not statistically decrease post operation septic arthritis.

 

References 

1.       Laurie MK ,Todd CB ,Paul P ,William RMA , David JH .A retrospective comparison of the incidence of bacterial infection following anterior cruciate ligament reconstruction with autograft versus allograft. Arthroscopy (journal).2008; 24: 1330-1335.

 2.         Tjoumakaris FP, Herz-Brown AL, Bowers AL, Sennett BJ, Bernstein J. Complications in brief: Anterior cruciate ligament reconstruction. Clin Orthop Relat Res. 2012 Feb; 470(2):630-6.

 3.         Judd d , Craig B ,David K , Matthew B , Shawn H. Infections fallowing arthroscopic anterior cruciate ligament reconstruction .Arthroscopy (journal) .2006 : 22 :375-384.

 4.         Scully WF, Fisher SG, Parada SA, Arrington EA.  Septic arthritis following anterior cruciate ligament reconstruction: a comprehensive review of the literature. J Surg Orthop Adv. 2013; 22 (2):127-33.

 5.         Demirağ B, Unal OK, Ozakin C. Graft retaining debridement in patients with septic arthritis after anterior cruciate ligament reconstruction. Acta Orthop Traumatol Turc. 2011;45(5):342-7

 6.        Arndt S, Sebastian G ,Hergo GKS ,Christian J ,Maximilian F. Septic arthritis of the knee after anterior cruciate ligament surgery. The American Journal of Sports Medicine.2007; 35(7):1064-9.

 7.      Namba RS, Inacio MC, Paxton EW. Risk factors associated with deep surgical site infections after primary total knee arthroplasty: an analysis of 56,216 knees. JBJS Am. 2013; 95(9):775-82.        

 8.       Nakayama H ,Yaqi M ,Yoshiya S ,Takesue Y. Micro-organism colonization and intraoperative contamination in patients undergoing arthroscopic anterior cruciate ligament reconstruction. Arthroscopy; 2012 May; 28(5):667-71.

 9.         Bortnem KD, Wetmore RW, Blackburn GW, Brownell SM, Page BJ. Analysis of therapeutic efficacy, cost and safety of gentamicin lavage solution in orthopedic surgery prophylaxis .Orthop Rev.1990Sep; 19(9):797-801.

 10.       Lescun TB, Adams SB, Wu CC, Bill RP, Van Sickle DC. Effects of continuous intra-articular infusion of gentamicin on synovial membrane and articular cartilage in the tarsocrural joint of horses. Am J Vet Res.2002 May; 63(5):683-7.

 11.       Kaya I, Sungur I, Yilmaz M, Pehlivanoglu F,et al. Comparison of the efficiency of different antibiotic irrigation solutions in decontamination of allografts contaminated with Staphylococcus aureus. Acta Orthop Traumatol Turc. 2013; 47(4):281-285

 12.                   Konstantinos A, Nora Verena S, Jens K , Ulrich G, Jochen J. Classification of hip joint infections. Int J Med Sci .2009; 6(5):227-233.

 13.       Fotios PT, Amy LHB, Andrea LB, Brian JS, Joseph B. Complication in Anterior cruciate ligament reconstruction. Clinical orthopedics and related research. 2012; 470 (2):631-6.

 14.       Torres-Claramunt R, Pelfort X, Erquicia J, Gil-González S, Gelber PE, Puig L, Monllau JC. Knee joint infection after ACL reconstruction: prevalence, management and functional outcomes. Knee Surg Sports Traumatol Arthrosc. 2012 Oct 27

 15.       Burks RT, Friederichs MG, Fink B, Luker MG, West HS, Greis PE. Treatment of postoperative anterior cruciate ligament infections with graft removal and early reimplantation. Am J Sports Med .2003; 31:414–418

 16.       SY Fong, JL Tan .Septic arthritis after arthroscopic anterior cruciate ligament reconstruction. Ann Acad Med Singapore .2004; 33:228-34.

17.       Cheng W, Yingfang Ao, Jianquan W, Yuelin Hu, Guoqing C , Jiakuo Y. Septic arthritis after arthroscopic Anterior cruciate ligament reconstruction. Arthroscopy.2009; 25(3):243-9.

 18.       Joss WM, Kasteren MV. Improving Prescribing in Surgical Prophylaxis. Antibiotic Policies: Theory and Practice.2005, kluwer academic publishers.1st Edition, chapter11.PP:188-90.

 19.       Wymenga A, van Horn J, Theeuwes A, Muytjens H, Slooff T. Cefuroxime for prevention of postoperative coxitis. One versus three doses tested in a randomized   multicenter study of 2,651 arthroplasties. Acta Orthop Scand. 1992; 63:19–24.

 20.       Chow JW, Fine MJ, Shlaes DM, Quinn JP, Hooper DC, Johnson MP et al. Enterobacter bacteremia: Clinical features and emergence of antibiotic resistance   during therapy. Ann. Intern. Med. 1991; 115: 585–590.

 21.       Rybak MJ, Abate BJ, Kang SL, Ruffing M J, Lerner S A, Drusano GL.  Prospective evaluation of the effect of an aminoglycoside dosing regimen on rates of observed nephrotoxicity and ototoxicity. Antimicrob. Agents Chemother.1999; 43:1549–55.

 22.       Christopher JV, Mark Q, Andrew J, Jane EG. A surgical technique using presoaked vancomycin hamstring grafts to decrease the risk of infection after anterior cruciate ligament reconstruction. Arthroscopy (journal) .2012; 28:337-342.

 23.       Niebuhr M, Mai  U, Kapp  A ,Werfel T Antibiotic treatment of cutaneous infections with Staphylococcus aureus in patients with atopic dermatitis: current antimicrobial resistances and susceptibilities. Exp Dermatol. 2008 Nov;17(11):953-7

 

 

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زانو درد مشکلی است که اغلب به دلیل فرسودگی زانو ایجاد می‌شود. این ناراحتی در هر فردی از سالخورده، تا میان‌سال و کودکان ممکن است دیده ‌شود. البته زنان بیش از مردان مستعد ابتلا به این مشکل هستند. Read More...
IMAGE زنان و درد زانو

  بابز کورن کسی است که دو مرکز ورزشی ژیمناستیک دارد. معمولا زنان به تناسب اندام خود حساس تر هستند ولی کورن معتقد است زنانی که در این باشگاه ورزش می کنند نباید با حرکات ورزشی غلط به سلامتی اعضای بدن خود آسیب بزنند. کورن می گوید: ” درد زانو چیزی است که تعداد نسبتا زیادی از افراد، آن را تجربه کرده اند.” تجربه درد زانو در زنان عجیب و غیر معمول نیست. چرا که کشیدگی رباط زانو یا ACL معمولا در زنان بیشتر از مردان می باشد. Read More...
IMAGE شایعترین آسیبهای زانو چیست؟

زانو یک ساختار پیچیده دارد و یکی از اغلب مفاصل تحت فشار در بدن است این بزرگترین مفصل و برای حرکت حیاتی و نسبت آسیب، آسیب پذیر می باشد. زانو از شایع ترین آسیب مفصل در ورزشکاران نوجوان با حدود 2.5 میلیون صدمات ناشی از ورزش در سال است. بسیاری از آسیب های زانو را می توان با موفقیت با اقدامات ساده، مانند بریس و تمرینات تقویتی درمان نمود آسیب های دیگر ممکن است نیاز به جراحی برای اصلاح داشته باشد. Read More...
IMAGE آشنایی با جراحی تعویض مفصل زانو

جراحی تعویض مفصل زانو می‌تواند درد ناشی از آرتروز شدید را تسکین دهد و به شما کمک کند، بهتر راه بروید. سایش تدریجی با افزایش سن، بیماری‌ها و جراحات ناشی از ضربات ممکن است به غضروف زانو که روی استخوان‌ها را می‌پوشاند آسیب برساند، و مانع از درست کار کردن مفصل زانو شود. اگر شما دچار آرتروز شدید زانو باشید، ممکن است پزشکتان به شما توصیه کند، جراحی تعویض مفصل زانو را انجام دهید. جراح در حین جراحی تعویض زانو غضروف و استخوان آسیب‌دیده را از مفصل زانوی شما برمی‌دارد و آن را با یک مفصل مصنوعی جایگزین می‌‌کند. این عمل را که "آرتروپلاستی زانو" هم می‌نامند، یکی از رایج‌ترین اعمال جراحی ارتوپدی است. Read More...
IMAGE درمان زانوی پرانتزی با ورزش

اگر از کسی که زانوی پرانتزی دارد بخواهید صاف بایستد، حتما متوجه این مشکل در دو سطح داخلی پاهای او می‌شوید.درست در قسمت داخلی مفاصل زانوها قوس بیش از حدی دیده می‌شود و استخوان‌های ران و ساق پاها در یک خط نیستند!   در اصطلاح زانوی پرانتزی به نوعی از تغییرشکل‌های زاویه‌دار زانو می‌گویند که در آن دو کندیل داخلی ران از یکدیگر فاصله گرفته و نمایی شبیه به کمان یا پرانتز ایجاد می‌کنند. Read More...
ساییدگی کشکک زانو (کندرومالاسی)

اگر ورزشکاری در طول ورزش خود از زانوها بسیار کار بکشد، مثل: دوچرخه سواری، عضله 4 ‌سر زانو ی او ضعیف شده و این عضله قدرت نگه‌داشتن کشکک زانو را ندارد، که این عمل باعث شده تا کشکک خود را بر روی غضروف انداخته و موجب خراشیدگی آن ‌شود، یا کشکک از جای اصلی خود تغییر مکان دهد.   Read More...
IMAGE اگر آرتروز زانو دارید بخوانید

عادت‌های نادرست در زندگی روزمره مانند نشستن به صورت چهارزانو، احتمال آسیب‌دیدگی مفصل زانو را افزایش می‌دهد. مفصل زانو از مهم‌ترین مفاصل بدن است که در هنگام انجام دادن تمامی فعالیت‌ها مانند ایستادن، راه رفتن و حتی نشستن در معرض فشار قرار دارد و به همین علت سلامت آن اهمیت زیادی پیدا می‌کند.متن زیر ما را با ساختمان زانو و مشکلات آن بیشتر آشنا می کند. Read More...
IMAGE ۱۰ روش طلایی برای تسکین زانو درد

این روز ها، زانو درد سن نمی شناسد و حتی جوانان را نیز درگیر می کند. زانو درد ممکن است به طور ناگهانی یا به مرور زمان بروز کند؛ افزون بر این، می تواند خیلی سریع وخیم شود. زانو درد علت های مختلفی دارد؛ از جمله آسیب دیدگی، عمل جراحی، کمبود ویتامین، آرتریت، بیماری یا برنامه غذایی ناسالم.   در این مطلب به نقل از «prevention» به ۱۰ نکته مهم برای تسکین زانودرد اشاره می کنیم. Read More...
IMAGE بعد از تعویض مفصل زانو در دراز مدت باید به چه نکاتی توجه داشت؟

برای بدست آوردن نتیجه خوب از عمل جراحی تعویض مفصل یا آرتروپلاستی زانو باید بعد از جراحی نکات متعددی را رعایت کرد. بدون رعایت این نکات دیر یا زود مفصل مصنوعی دچار مشکل میشود. این فکر که پزشک جراح ارتوپدموقع عمل جراحی تمام کارها را انجام داده و عمل با موفقیت تمام شده درست نیست. بسیاری کارها و مراقبت ها هستند که باید بعد از جراحی انجام شوند. بعد از جراحی تعویض مفصل زانو باید از انجام ورزش های شدید بدنی اجتناب کرد. خم کردن شدید مفصل زانو ممکن است موجب آسیب دیدن آن شود پس باید از این کار اجتناب کرد. بطور مثال استفاده از توالت های سنتی بعد از جراحی درست نیست. مفاصل طبیعی بدن همه انسانها با کهولت دچار سائیدگی و تخریب میشوند. این جرئی از روند طبیعی پیری است. پس مفاصل بدن و از جمله مفصل زانو عمر محدودی دارد. نمیتوان از مفصل مصنوعی انتظار عمری ابدی داشت.  Read More...
IMAGE تقویت عضلات زانو با تمرینات ورزشی

مفصل زانو از آنجا که یکی از مفاصل پرتحرک بدن است، بیشتر در معرض آسیب قرار دارد و چون وزن بدن را تحمل می کند، تحت فشار بیشتری نیز قرار دارد. در این مطلب ورزش هایی برای بازتوانی ماهیچه های اطراف زانو پیشنهاد می شود که برای بهبود پایدار دردهای مزمن، بازتوانی و تقویت ماهیچه ها ضروری است.   Read More...
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دکترحمیدرضا یزدی

جراح و متخصص بیماریهای زانو 

تهران، خیابان قائم مقام فراهانی، بالاتر از مطهری، کوچه چهارم، پلاک ۲۰، واحد ۱۳٫

شماره های تماس : ۰۲۱۸۸۵۲۵۸۵۹ – ۰۲۱۸۸۵۳۲۵۸۹     

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