| Purpose: The purpose of this literature is to report tour experience of using Debridement,Antibiotics and Implant Retention(DAIR)in the treatment of acute periprosthetic joint infection(PJI),and initially analyze the reasons for successful treatment.Methods: A retrospective analysis of 27 cases of PJI from June 2013 to June 2018 in the Department of Joint Surgery,the First Affiliated Hospital of Fujian Medical University,diagnosed as PJI according to MSIS diagnostic criteria and treated with DAIR.Patient’s age,gender,body mass index(BMI),comorbidities,duration of symptoms,preoperative sinus,preoperative and follow-up C-reactive protein levels(CRP)and erythrocyte sedimentation rate(ESR),preoperative Synovial Fluid Leukocyte Count(SF-WBC),Synovial Fluid Neutrophils%(SF-PMN%),the pathogen identification results and the main drug susceptibility results were recorded.After regular follow-up,the patient’s last review of inflammation and imaging results were recorded,and knee and hip joints were scored using Knee Society Score(KSS)and Harris Hip Score(HHS)scores,respectively.Result:A total of 27 cases were included,A complete follow-up of 24 patients was obtained.3 patients were lost to follow or died.The average follow-up time was26.71 months(7-63 months).Among them,22 cases were successfully treated,2 case failed,and the infection control rate was 91.7%.The CRP and ESR at the last follow-up were significantly lower than those at the preoperative level(CRP:5.40±3.50 VS 52.59±33.98,P=0.00;ESR:20.16±12.10 vs 72.29±34.27,P=0.00),functional score(73.86±22.99 VS 8.09±3.47,P=0.00),and hip HHS score(84.12±15.14 VS 34.41±6.85,P=0.00)were significantly improved compared withthe preoperative level.The pathogens were identified by various methods such as optimized culture,ultrasonic lysis,PCR,and second-generation sequencing.The positive rate of pathogens was 91.6%,and the positive rate of bacterial detection by the second-generation sequencing method in 10 cases was 100%.The success rates of treatment with Staphylococcus aureus,Streptococcus and other pathogens were 100%,83.3%,and 92.8%,respectively.There was no statistically significant difference(P=0.67).The duration of symptoms was less than or equal to 4 weeks in 19 cases,of which 17 cases were successful,the debridement success rate was 89.4%,5 cases were symptom duration longer than 4 weeks and less than or equal to 8 weeks,and the debridement success rate was 100%.There was no significant statistical difference in the rate(P = 1.00).Conclusion:Treatment of acute PJI by DAIR has better infection control rate and prognosis.In this group of studies,patients with symptom duration within 8 weeks were treated with DAIR for PJI.The prognosis of PJI caused by Staphylococcus aureus,Streptococcus and other pathogens was not significantly different.The possible reasons for success are the high positive rate of pathogens and strict control of surgical indications. |
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