Clinical Study Of Complications Related To Arthroplasty

PART 1: THE OPTIMAL ADMINISTRATION ROUTE OFTRANEXAMIC ACIDINTRA-ARTICULAR APPLICATION IS MORE EFFECTIVE THAN INTRAVENOUS APPLICATION OFTRANEXAMIC ACID IN TOTAL KNEEARTHROPLASTY: A PROSPECTIVE RANDOMIZEDCONTROLLED TRIALPurpose: The optimal administration route of tranexamic acid(TXA)in total knee arthroplasty(TKA),and the effect of TXA on hidden blood loss and total blood loss are undetermined.The purpose of this study was to compare the effectiveness of intravenous versus intraarticular application of tranexamic acid in patients undergoing knee arthroplasty.Methods: A total of 150 patients undergoing primary unilateral total knee arthroplasty were randomly distributed to 3 groups(IV,intraarticular,and control group;each 50 patients)and administrated TXA(1 g IV and 50 m L intra-articular saline,1 g intra-articular and 50 m L intraarticular saline,and 0 g and 50 m L intra-articular saline,respectively).The amount of total and hidden blood loss(HBL),drainage,transfusion,changes in hemoglobin levels,and complications were recorded.Results: Intra-articular use of TXA reduced more total blood loss(P=0.011)and reduced more total 48 hours' drainage volume than IV use of TXA(P <.001).Two patients received transfusion in IV and control group.No deep venous thrombosis or other severe complications had occurred.The HBL volume had no significant difference among the control,IV,and intra-articular groups(708.6 ± 308.2,651.7 ± 302.9,and 625.2 ± 252.1 m L,respectively;which was 65.6%,70.8%,and 81.1% of the total loss).Conclusion: Intra-articular administration of TXA significantly reduced total blood loss and drainage volume to a greater degree than IV injection in total knee arthroplasty without reduction of HBL.PART 2: OUTCOME OF PERIPROSTHETIC JOINTINFECTION PATIENTS AFTER TWO-STAGEREVISION COMPARABLE OUTCOMES OF CULTURE-NEGATIVEAND CULTURE-POSITIVE PERIPROSTHETIC HIPJOINT INFECTIONS FOR PATIENTS UNDERGOINGTWO-STAGE REVISIONPurpose: Lack of perioperative microbiological evidence is an unfavorable factor in one-stage revision.The objective of this study was to figure out whether being culture negative was an unfavorable factor for periprosthetic hip joint infection(PHJI)in patients undergoing two-stage revision.Methods: Records of PHJI patients treated between October 2003 and December 2016 were reviewed at our institution.Information such as microbiological data,clinical outcomes and other details of patients' clinical courses were recorded and analyzed.Results: A total of the 58 cases were reviewed.The median followup duration was 68.5 months.The infection control rate of PHJI was 93.1% after two-stage revision.Kaplan-Meier analysis showed no significant difference in infection control rates between culture-negative and culture-positive groups.Culture-positive sinus secretions were significantly associated with an increased rate of reinfection(P = 0.039).Conclusions: Two-stage revision had a high success rate for eradication of PHJI.Culture-negative PHJI had a comparable outcome with culture-positive PHJI.COMPARISON OF GRAM-NEGATIVE AND GRAM-POSITIVE PROSTHETIC JOINT INFECTION FORPATIENTS UNDERGOING TWO-STAGE REVISIONPurpose: The difference of infection control rates between Grampositive(GP)and Gram-negative(GN)PJI for patients undergoing 2-stage revision is still controversial.The objective of this study was to figure out whether Gram-negative was an unfavorable factor for periprosthetic joint infection(PJI)patients undergoing two-stage revision.Methods: Patients with GP PJI and GN PJI from August 2004 to December 2016 were reviewed at our institution.Information such as demographic characteristics,clinical outcome and other details of clinical course were recorded and analyzed.Results: A total of the 73 cases were reviewed.The mean follow-up duration was 57.2 months.The infection control rate of GN PJI was 61.5%(8/13),comparing with 86.6%(52/60)for GP PJI.Kaplan-Meier analysis showed that patients with GN PJI had a lower cum survival rate of infection control(P=0.018).A multivariate Cox regression analysis revealed that knee(vs.hip)(P=0.031),sinus tract(P=0.018)and multiantibiotic-resistant bacteria(P=0.028)were independent risk factors for recurrence of infection.Conclusion: In patients undergoing 2-stage revision,GN PJI is difficult to treat and had a worse outcome comparing with GP PJI.DIFFERENCES OF CHARACTERISTICS ANDINFECTION CONTROL OUTCOME BETWEEN KNEEAND HIP PROSTHETIC JOINT INFECTION FORPATIENTS UNDERGOING TWO-STAGE REVISION.Purpose The characteristics and infection control outcome between knee and hip periprosthetic joint infection(PJI)for patients undergoing 2-stage revision is still not well known.The objective of this study was to find out the differences between them.Methods Patients with hip PJI and knee PJI from March 2011 to December 2016 were reviewed at our institution.Information such as demographic characteristics,clinical outcome and other correlated details were recorded and analyzed.Results A total of the 58 cases were reviewed.The mean follow-up duration was 38.5 months.Kaplan-Meier analysis showed that patients with knee PJI had a lower cum survival rate of infection control(P=0.030).The 5-year(60-month)infection free survival rate for hip PJI was 95.0%,and 74.8% for knee PJI,respectively.A multivariate Cox regression analysis revealed that knee(vs.hip)(P=0.012),presence of sinus tract(P=0.011),male(vs.female)(P=0.012)were independent risk factors for recurrence of infection.Conclusion In patients undergoing 2-stage revision,knee PJI is more difficult to be eradicated comparing with hip PJI.