Analysis Of The Causes Of Infection Around The Joint Prosthesis And The Study Of The Treatment Effect

PART Ⅰ Treatment options and prognosis of infection after total knee arthroplastyObjective:To investigate surgical interventions for periprosthetic joint infection(PJI)after total knee arthroplasty and characteristics of prognosis.Method:Sixty two patients with PJI after total knee arthroplasty from January 2000 to November 2016 were reviewed retrospectively,included with 17 male and 45 female.The mean age was 66.0±10.2 years old(37-85).Fourty-nine patients were diagnosed with osteoarthritis,9 with rheumatoid arthritis,2 with secondary ankyloses after suppurative arthritis and 2 with hemophilia arthritis.Forty-one patients underwent unilateral total knee arthroplasties,and 21 bilateral total knee arthroplasties.Characteristics of PJI,including infection types,existence of sinus tract,infectious pathogen,surgical intervention and patients’ prognosis,were collected.Result:Twenty four patients underwent open debridement with prothesis reten-tion.In the 14 successful cases,medial time interval between primary total knee arthroplasty and debridement was 33 days.One case of positive Methicillin resistant Staphylococcus aureus culture of joint aspiration,and 1 case formed sinus tract.In 10 cases of failed debridement,the medial time interval was 270 d.Intra-articular culture presented 4 cases of antibiotic resistant bacteria,and 6 cases formed sinus tract.Except for one patient gave up treatment and another received arthrodesis,the other 8 failed cases were all treated with revisions.In 46 revisions,nine patients underwent one-stage revisions.The mean time interval between primary total knee arthroplasty and revision was 15.9 ± 14.5 d.Intra-articular culture presented 3 cases of antibiotic resistant bacteria,and 1 case formed sinus tract.In the other 37 two-stage revisions,the mean time interval was 1045.7±1044.1 d.Intra-articular culture showed 15 cases of antibiotic resistant bacteria,and 12 cases formed sinus tract.The mean follow-up duration was 73.9±48.2 months.At the last follow-up,all patients were free of antibiotics treatment.The mean Knee Society Score(KSS)was 85.9±4.3 after successful open debridement with prothesis retention.The KSS of one-stage revision patients was 78.5±3.3,while that of two-stage revision patients was 65.7±7.4.Statistical difference was found among groups(P<0.05).Conclusion:For PJI within 3 weeks after total knee arthroplasty without sinus tract or intra-articular culture of antibiotic resistant bacteria,open debridement with prosthesis retention could be recommended.One-stage revision could be applied in infectious cases which appeared between 3 weeks to 1 month after primary surgery or in cases with unstable prostheses found in open debridement.For infectious cases longer than 1 month after primary procedure or those with sinus tract,severe soft tissue deficiency,intra-articular culture of antibiotic resistant bacteria,two-stage revision could be recommended.PART Ⅱ Cross-sectional survey of peri joint infections after joint replacement in Beijing between 2014 and 2016Objective:To analyze the postoperative revision rate and surgical intervention of perijoint infections after joint replacement in Beijing,ChinaMethods:Retrospectively collected data of patients diagnosed with perijoint infections after joint replacement(THR and TKR)in nine hospitals in Beijing from 2014 to 2016,including age,gender,body mass index(BMI),primary preoperative diagnosis,preoperative complications and primary surgeries.Analyze the postoperative revision rate of postoperative perijoint infections,surgical interventions and complications.Result:A total of 37836 cases of joint arthroplasty were performed in nine hospitals in Beijing between 2014 to 2016,including 12113 cases,13129 cases,and 12594 cases in 2014,2015,and 2016,respectively.Among them,there were a total of 366(0.97%)infected revisions consisted of 48(13.1%)acute infections and 318(86.9%)late infections.From 2014 to 2016,13964 hip replacements were performed including 161(1.15%)infected hip revisions and 23,872 knee replacements including 205(0.86%)infected knee revisions.Of the 366 infected revisions,149(40.7%)were postoperative peri joint infections whose primary replacement was performed in these nine hospitals while the other 217(59.3%)were not.Among those 149 infected cases,40 cases whose primary replacement were completed before 2014,while the remaining 109 cases had their primary arthroplasties finished between 2014 and 2016:58 cases completed in 2014 with a postoperative revision rate of 0.48%(58/12113),33 cases in 2015 with a postoperative revision rate of 0.25%(33/13129)and 18 cases in 2016,with a postoperative revision rate of 0.14%(18/12594).The total postoperative revision rate between 2014 to 2016 was 0.29%(109/37836).The surgical treatment of peri joint innfection after hip replacement was mostly two-stage revision(75.2%),followed by one-stage revision(19.9%).And the surgical treatment of perijoint innfection after knee replacement was mostly two-stage revision(69.8%),followed by open debridement with prosthesis retention(22.0%).Postoperative complications occurred in 17(4.6%)cases.Conclusion:The total postoperative revision rate of perijoint innfection among those nine hospitals in Beijing between 2014 to 2016 was 0.29%,which might be underestimated.The majority of infections after joint replacement were delayed infections.The surgical treatment for those infections was mainly two-stage revision using antibiotic bone cement spacers.