Effect Analysis Of Local Application Of Drug-Loaded Calcium Sulfate Granules Combined With DAIR On Acute Periprosthetic Joint Infection

Background Periprosthetic joint infection(PJI)is one of the most serious complications after artificial joint replacement,it’s called a"catastrophic" complication,the treatment method is complicated and the treatment period is very long,with makes the patients suffer great pain and high treatment costs.PJI is treated in different ways according to the period of infection,including antibiotic therapy alone,debridement of retained prosthesis(DAIR),primary revision surgery and secondary revision surgery.For the acute infection after joint replacement,the use of debridement with prosthesis retention,namely Debridement,Antibiotics,Implant Retention(DAIR)has become a common consensus.At present,there are different reports on the success rate of traditional DAIR on infection control and prosthesis retention,which caused some disputes exist.The drug-loaded self-curing calcium sulfate granules are used as a drug slow-release system around the joints.Furthermore,the local drug release concentration is high,which has a significant effect on improving control rate and the success rate of prosthesis retention.At the same time,the drug-loaded calcium sulfate particles have the advantages of good biocompatibility,fast degradation,low strength,no wear to the prosthesis and can be completely absorbed by the body,so they can be applied to DAIR surgery of acute infection after joint replacement.In this study,follow-up analysis of acute infection patients treated with local drug-loaded calcium sulfate granules combined with DAIR was performed to evaluate the efficacy.Objective To evaluate the clinical effect of local application of drug-loaded calcium sulfate granule combined with prosthesis retention debridement(DAIR)on acute periprosthetic infection(PJI)treatment after joint replacement,and to analyze the factors affevting the success of operation as well as the risk factors of leading to the failure of prosthesis retention.Methods Retrospective analysis 34 patients with acute periprosthetic infection admitted from 2014 to 2019 were performed,including 12 males and 22 females,aged 53-78 years,mean age(65.8±8.1 years),23 cases of knee joint and 11 cases of hip joint,14 patients with hypertension,7 patients with diabetes and 3 patients with coronary heart disease.All of which were acute periprosthetic infection within 3 months after the operation and the time from symptoms of infection to debridement surgery was 3-120 days,with an average of 47.6 days.All patients were treated with local debridement(DAIR)of drug-loaded calcium sulfate combined with retained prosthesis,and patients infection control status was regularly followed up for infection control status.The blood sedimentation rate,c-reactive protein,X-ray manifestations,KSS score of knee joint and Harris score of hip joint were recorded for all patients.Results As of January 1,2020,34 patients were follow-up,4-66 months,with an average of(22.5±17.3)months.All surgical incision were primary healing,32 patients were controlled for infection and the prosthesis retain was successful.The infection control rate was 94.1%(32/34),2 cases of had recurrence of infection for their knee joints,recovered after one-stage revision surgery,.Patients with infection recurrence were preoperative joint puncture bacterial culture negative.At 3 months after the operation,ESR(68.9±26.7)mm/h decreased significantly compared with those before the operation(12.3±10.0)mm/h(P<0.01),as well as,the CRP which decreased from(67.1±49.6)mol/l to(9.8±5.3)mol/l(P<0.01).The joint function was significantly improved for KSS score of knee increased from an average of(39.6±9.1)points before surgery to an average of(82.9±4.2)points after suegery(P<0.01).The Harrris score of hip joint increased from an average(29.7±10.3)before surgery to an average(84.3±4.1)after suegery(P<0.01),X-ray examination showed no signs of prosthesis loosening.Conclusion The local application of drug-loaded calcium sulfate granules combined with Debridement,Antibiotics,Implant Retention(DAIR)is an effective method for the treatment of acute infection after joint replacement.Early and complete debridement and the use of local drug-loaded sustained release system are the keys to preventing the recurrence of infection and the success of prosthesis retention.Delayed infection,long course of disease and the inability to determine the bacterial culture are the main risk factors for failure to retain the prosthesis.