Clinical Research Of The Perioperative Comprehensive Treatment Of Acute Prosthetic Joint Infection

Purpose Acute prosthetic joint infections(APJI) is one of the major complications of the total joint arthroplasty,often occurs in the early postoperative period or hematogenous dissemination.the perioperative comprehensive treatment that contains retention of the prosthesis、debridement and antibiotic using is one of the major treatment for APJI,and the success rate of the early measures is higher, about 60-80%. This study was designed to investigate the therapeutic effect of APJI after taking the retention of the prosthesis、debridement and antibiotic using.Methods We retrospectively evaluated the 14 cases of APJI were treated with retained prosthesis and debridement after the total joint arthroplasty in our hospital from 2011 to 2014,including 6 cases of infection after total hip arthroplasty(1 case was lost to follow-up, actually follow-up 5 cases), 8 cases of infection of total knee arthroplasty.The cases need preoperative routine examination of C reactive protein(CRP) and procalcitonin(PCT).All patients underwent preoperative arthrocentesis for the bacterial culture,and intraoperative routine examination and bacterial culture of the joint fluid.The femoral head must be left and the intra-articular inflammatory lesions must be clean-up thoroughly in the cases of Hip joint.The polyethylene insert must be removed and replaced the new,cleaning up the suspicious lesions of infection within posterior medial capsule in the knee joint.Routine indwelling drainage tube and using local antibiotic treatment in the joint.All cases used corresponding sensitive antibiotic for 3 month after the treatment of retained prosthesis and debridement surgery,and regularly follow-up CRP index, ESR,joint function.Results ①In the 13 cases of APJI taken to retain the prosthesis prosthesis,the average follow-up 20.69 months(9.15-35.45 mo),including 9 cases of preliminary success retained prosthesis, average follow-up time of 17.33 months(7.50-7.50 months), norecurrence of infection.Another 4 cases of retained prosthesis failure(knee 3 cases, 1 case of hip); the average follow-up time of 28.25 months(5.33-5.33 months).The success rate was 69.2%.② The onset of symptoms to debridement average interval time of the 9 successful patients was 14.44 d(9.00-20.67d),and the onset of symptoms to debridement average interval time of the failure cases was 7.5 d(4-10 d), two groups of debridement average interval time by t test, there was no significant difference(t=1.449,P>0.005).③In 13 cases of APJI,the preoperative or intraoperative germiculture results showed that: 9 cases of staphylococcus infection, accounted for 69.2%, including staphylococcus aureus infection in 2 cases, Meticillin-resistant Staphylococcus aureus 1 case,4 cases by staphylococcus epidermidis(including Methicillin-resistant Staphycoccus aureus epidermidis 3 cases),staphylococcus capitis in 1 case,staphylococcus haemolyticus in 1 case.The remaining pathogens three cases of E. coli, 27.3%; and finally one case of E.faecalis.Conclusion The treatment of debridement and irrigation has certain value in the treatment of APJI, the successful rate was 69.2%,and fully grasp the opportunity and indication.