A Study On Peri-prosthetic Joint Infection After Total Joint Replacement Treated By Two-stage Revision And Its Predictive Factor

PurposesThe purpose of our study was to determine:(1)whether the clinical manifestations are the same between SA and CoNS,which have different intrinsic virulences;the differience of clinical manifestation between Methicillin-sensitive Coagulase-negative staphylococcus(MSCoN)and Methicillin-resistant Coagulase-negative staphylococcus(MRCoN).(2)whether the eradication rate of infection is different between S A and CoNS with two-stage revision;and to compare the results differience between Methicillin-sensitive Coagulase-negative staphylococcus(MSCoN)and Methicillin-resistant Coagulase-negative staphylococcus(MRCoN)treated by two-stage revision;and(3)which risk factors may affect the final outcomes after two-stage revision.(4)To analyse the clinical characteristics of periprosthetic joint infection caused by rare fungal.MethodsWe retrospectively collected 260 arthroplasty patients who underwent a two-stage revision because of PJI from January 2003 to June 2015 in our institute because of PJI.Sixty-four patients(36 hips and 28 knees)and 23 patients(13 hips and 10 knees)were infected by coagulase-negative staphylococci(CoNS)and SA,respectively.And there were 18 joints(13 knees and 5 hip)of 17 patients(10 female and 7 male)were identified infection by fungal at our institute.ResultsIn the SA and CoNS group,the preoperative mean ESR value of the SA group was higher than that of the CoNS group(median,60.9 VS 35.9;P<0.001).Seventeen(73.9%)of the 23 SA infected patients had a sinus tract,while only 12(18.8%)of the 64 CoNS-infected patients had this symptom(73.9%VS 18.8%;P<0.001).At the time of follow-up,58(90.6%)of the 64 CoNS-infected patients had successfully controlled the infection.In the SA group,20(87.0%)patients ultimately acquired successful control(90.6%VS 87.0%;P=0.923).Surgical history was identified as a potential risk factor(OR=6.2,95%CI 1.17—32.4)for prognosis when potential covariates were adjusted.In the MSCoN and MRCoN group,after 81.7 ±38.3 months and 65.9±33.8 months follow-up,the success rate of MSCoN group and MRCoN group was 92%and 84.4%respectively.There wes no significant difference between two groups(P=0.643).Patients who had surgery history were 4.04 times higher of failure than who had not(OR=4.04,95%CI,0.62-26.5).Patients who had sinus tract were 4.26 times higher of failure than who had not(OR=4.26,95%CI,0.7-25.9).In the fungal group,15 patients were infected by Candida species,molds were isolated in 3 patients.The median duration of resection arthroplasty and reimplantation was 33.9 weeks(range,12 weeks to 132 weeks),13(10 knees and 3 hips,72.2%)of the 18 patients(13knees and 5 hips)had not happen recurrent or persistent infection,5(3knees and 2 hips,27.8%)of the 18 patients(13knees and 5hips)failed to control infection after reimplantation prosthesis or spacer.longer interval between prosthesis resection and reimplantation(69 weeks VS 23.1 weeks,p=0.240),mixed bacterial infection(80%VS 46.2%,p=0.314)were related to higher failure rate.ConclusionsIn conclusion,SA infection has a higher ESR value,and sinus tract occurs more frequently compared to CoNS infection.Two-stage revision is an ideal treatment protocol for SA and CoNS species,as there is no statistically significant difference in the eradication rate of infection between the SA and CoNS groups.Surgical history may be a good predictor of failure in PJI treated with two-stage revisionTwo-stage revision is an effective procedure in treating patients infected by MSCoN and MRCoN.There is no significant difference of treatment failure betweent MSCoN and MRCoN group by two-stage revision.Surgery history and sinus tract maybe risk factors of treatment failure,while Methicillin-resistant is not.For fungal PJI,debridement with the retention of the prosthesis is not an ideal treatment protocol for fungal PJI,two-stage revision could be efficient.We suggest that 6 weeks parenteral antifungal agents is necessary,6 weeks oral antifungal treatment followed is also important.We do not recommend patients who had more than 2 host risk factors performed two-stage revision.