Clinical Analysis Of The Late Deep Prosthetic Joint Infection

Infection after artificial joint replacement is a devastating complication. Ratio of late infection after artificial joint is maintained at 0.5%-1%. Despite the relatively low of infection rate,, more and more difficult to cure the infection for the emergence of resistant strains The purpose of study was analysis the late deep prosthetic joint infection cases, which were performed operation in our hospital in recent year, to guide the clinic prevention and treatment. The study was included three parts.1. The microbiology analysis of the late prosthetic joint infectionObjective:To summary the type and number of pathogens and their antibiotic sensitivity in patients with late prosthetic joint infection in order to offer information for treatment. Method:We performed a retrospective analysis of 113 patients that specimens were obtained at the time of a reoperation following a total hip/knee arthroplasty at our institutions since Jau2002 to Aug 2010. Patient demographic data, bacterial species and the antibiotic sensitivity profile were recorded. Results:A total of 113 cases of this group of patients (THA 62,TKA51),48 cases was infected THA was cultured positive in 62 cases,39 cases of infected THA was cultured positive in 51 cases. The ratio of positive culture was 77.88% (88/113), and the Gram-positive bacteria accounted for 82.11% (78/95), Gram-negative bacteria 13.68% (13/95), fungi accounted for 4.21% (4/95). The ratio of resistance was 58.21% in cefuroxime,45.07% in cefazolin, and Staphylococcus methicillin-resistant Staphylococcus aureus rate was 46.87 percent. Conclusion:The late prosthetic joint infection were mainly cased by Gram positive bacteria. A higher proportion of resistant strains were detected, pharmacotherapy should guided by the susceptibility results. Second-generation cephalosporins were not suitable for prevent infection in patients who has risk factors of infection, and vancomycin was plays an important role in the prevention and treatment of infection, which can be used as first-line drugs.2. Analysis of risk factors for late prosthetic joint infectionObjective:To analyze the risk factors of late prosthetic joint infection. Methods:A retrospective case-control study to analysis the risk factors of the infected arthroplasty from the infected patients(30 cases) which were performed operation in PLA general hospital from January 2000 to January 2010, and non-infected patients randomly selected 120 patients as the control group. The x2 test was used for statistical significance. Results:Bone tumor, revision surgery, fracture surgery, surgery duration> 2h, postoperative drainage time> 48h, wound complications, have a statistically significant increased in the risk factors for infection; diabetes, rheumatoid joints, multi-joint surgery, infection during follow-up surgery have no statistical significance. Conclusion:Bone tumors, revision surgery, fracture surgery, surgery duration> 2h, postoperative drainage time> 48h and wound complications were the risk factors for infection after arthroplasty.3. Treatment of late prosthetic joint infection using articulating antibiotic bone cement spacerObjective:To summarize the experience of the using antibiotic-loaded cement articulating spacer made by a self-made mold system for cure of the infected arthroplasty, and to evaluate its efficiency and role in the two-stage revison of infected arthroplasty. Methods:We reviewed the patients who were infected THA and TKA, treated with two-stage revision protocol from August 2002 to July 2010. All of the 113 patients were adopt,98 cases debridement thoroughly and followed by implantation of an antibiotic-loaded cement articulated spacer made by a self-made mold system; two-stage revisions were not followed until the infection were controlled. All patients were gotten followed up. Evaluations were made for the efficiency of infection control, convenience of making, implant at ingand removing of the spacers, occurring of complications, the deal of the special circumstances, the function and satisfaction of the patients. Results:The cases were treated with the spacer get a rate of 95.92% of infection control, function improved significantly, satisfaction rate of 93.88%; after stage revision articulated in the final follow-up, and the overall infection control spacer was 93.88%. Conclusion:Antibiotic-loaded cement articulating spacer made by a self-made mold system which is a effective methods for the two-stage revision of the infected arthroplasty, characterized by simple, good reproducible, high rates of infection control, better joint function after surgeries, high rate of patients satisfaction and other advantages. It can reduce complications by improving the way. The ratio of added antibiotics have well treatment effect, throughout explore. We think it was the optimal spacer in the two-stage revisons for the infected arthroplasty so far in China, being worth to more extensively use.