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CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2025; 66(01): e42-e52
DOI: 10.1055/s-0045-1809038
Artículo de Revisión | Review Article

Manejo de la Infección Periprotésica. Revisión de la Literatura Actual y Algoritmo de Manejo

Article in several languages: español | English
Joan Olucha Puchol 
1   Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España
,
Luis Díaz Aviñó
1   Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España
,
Prario Massimino Paula
1   Servicio de Cirugía Ortopédica y Traumatología, Hospital Clínico Universitario de Valencia, Valencia, España
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Resumen

Objetivo Este artículo revisa exhaustivamente el manejo de la infección periprotésica en ortopedia, basándose en consensos internacionales recientes para guiar un enfoque terapéutico que asegure la recuperación funcional del paciente.

Materiales y Métodos Se exploran diversas estrategias terapéuticas, como el desbridamiento con retención del implante (DAIR), recambios en uno y dos tiempos, y el uso de espaciadores de liberación antibiótica. Se presentan escalas de predicción como CRIME80 y KLIC para evaluar el riesgo de fracaso en cada intervención.

Resultados El DAIR tiene una tasa de éxito aproximada del 71% en infecciones agudas, siempre que se cumplan criterios específicos, como una duración corta de los síntomas y microorganismos sensibles a los antibióticos disponibles. Las escalas CRIME80 y KLIC permiten estimar el riesgo de fracaso en infecciones agudas y postquirúrgicas, respectivamente. El recambio en un solo tiempo es viable en pacientes seleccionados, aunque el recambio en dos tiempos sigue siendo el estándar para casos complejos.

Discusión Los resultados subrayan que un abordaje multidisciplinario, incluyendo microbiología y enfermedades infecciosas, y el uso de escalas predictivas son esenciales para mejorar los resultados terapéuticos y personalizar el tratamiento.

Conclusiones El éxito en el manejo de la infección periprotésica exige un enfoque que considere la biología del biofilm y permita una selección cuidadosa del tratamiento. Al integrar los últimos avances en diagnóstico y tratamiento quirúrgico, se pueden mejorar significativamente los resultados clínicos y la calidad de vida del paciente.

Nivel de evidencia: IV.

Palabras clave

infección periprotésica - DAIR - revisión quirúrgica en dos tiempos - revisión quirúrgica en un tiempo - infección en artroplastia de cadera


Publication History

Received: 19 March 2025

Accepted: 02 April 2025

Article published online:
20 May 2025

© 2025. Sociedad Chilena de Ortopedia y Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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