| Objectives:Many kinds of diseases lead to the gradual increase of end-stage arthritis.However,as one of the common complications of surgery,infection is an important problem for surgeons.As China enters an aging society,a variety of patients are getting older and associated with a variety of medical diseases,and their immune ability declines.After prosthesis implantation,the number of patients infected around the prosthesis is increasing year by year due to bacteria and metal attachment.The misdiagnosis,missed diagnosis or early treatment of the infection around the prosthesis not only extends the hospitalization time of the patient,brings great pain and suffering to the patient,affects the prognosis of the patient,but also brings great economic burden to the family and society.At present,there is no clear definition of infection around the prosthesis.The detection of white blood cell count,CRP and ESR after hip replacement is the most simple and practical indicator of infection.White blood cell count,CRP and ESR are early inflammatory indicators,which are widely used in the detection of early infection after various surgeries because of their rapid postoperative response and short time of decline.There are many studies on the change trend of various inflammatory indicators after joint replacement by domestic and foreign scholars.Some studies have been conducted together with hip and knee replacement,some with different approaches,and some with patients with different diseases.Different types of diseases and approaches will inevitably increase the research base.Therefore,joint secretions were taken for culture and drug sensitivity during conventional surgery,and intra-articular synovial membrane was taken for pathological examination.In combination with clinical manifestations,preoperative inflammatory indicators and imaging examination,the patient was ensured to be free of infection before surgery,and the change trend and clinical significance of inflammatory indicators after hip replacement for patients with different diseases were discussed.Methods:A retrospective analysis was performed on 145 cases of unilateral hip arthroplasty in our hospital from December 2014 to December 2017 that met inclusion criteria,aged 17-84(55.49 ± 15.37).Among them,98 patients with ischemic necrosis of femoral head were divided into 2 groups according to different approaches,18 patients with direct anterior approach and 18 patients with posterior lateral approach.18 cases of ankylosing spondylitis;29 cases of rheumatoid arthritis.The posterior lateral approach was performed in both groups.Preoperative and postoperative 1,3,5,7,9,14 and 30 days respectively extraction in patients with peripheral blood,test WBC count,CRP,ESR value,six months of follow-up,139 of them have no infection occurred,including six early infection,patients appeared around the prosthesis,after a period after debridement,replace the gasket,retained prosthesis,followed up for six months,no recurrence of infection.Results:1.In patients with ischemic necrosis of femoral head,direct anterior total hip replacement was performed in non-infected patients,and the white blood cell count was significantly increased and reached a peak on the first day after surgery(11.72±3.56)×109/L,and then decreased gradually,and fell to the normal range on the third day after surgery(8.37 ±2.22)×109/L.CRP was significantly increased and reached a peak value(9.51 ±4.40)mg/L on the 3rd day after surgery,and then decreased gradually and decreased to normal(4.57±1.02)mg/L on the 14th day after surgery.ESR continued to increase after surgery,and reached the peak value(90.30 ± 35.23)mm/h 7 days after surgery,followed by a slow decline,and reached the normal value(11.28± 5.48)mm/h 1 month after surgery.In patients with unilateral total hip arthroplasty by posterolateral approach,the white blood cell count was significantly increased and reached a peak value(10.45 ± 2.69)x 109/L,which was then gradually decreased and decreased to the normal range(7.19 ± 1.63)x 109/L on the third day after surgery.CRP was significantly increased and reached a peak value(9.13 ± 3.97)mg/L on the third day after surgery,and then decreased gradually and decreased to normal(3.50 ± 1.22)mg/L on the 14th day after surgery.ESR continued to increase after surgery,and reached the peak value(90.30 ±35.23)mm/h 7 days after surgery,followed by a slow decline,and reached the normal value(10.08 ±3.32)mm/h 1 month after surgery.2.When ankylosing spondylitis received unilateral total hip replacement by the posterolateral approach,the WBC count increased significantly and reached a peak(11.75 ± 3.65)×109/L.On the first day after surgery,and then decreased gradually,falling to the normal range(7.74 ± 2.77)x 109/L,on the third day after surgery.CRP increased significantly and reached a peak value(11.21 ± 4.99)mg/L on the 3rd day after surgery,and then decreased gradually and decreased to normal(4.21 ±1.09)mg/L on the 14th day after surgery.ESR was higher than normal(27.30 ±19.83)mm/h before surgery,and decreased(21.60 ±17.47)mm/h on the first day after surgery,and then increased gradually,reaching the peak(98.30±19.83)mm/h on the seventh day after surgery,followed by a slow decrease,and decreased to the preoperative level(27.25 ±17.78)mm/h on the 30th day after surgery.3.In patients with rheumatoid arthritis treated with unilateral total hip replacement by the posterolateral approach,the white blood cell count increased significantly and reached a peak on the first day after surgery(8,15 ± 1.99)× 109/L,and then decreased gradually and dropped to the normal range on the third day after surgery(6.42± 1.56)x 109/L.CRP was significantly increased and reached a peak(10.92 ± 4.13)mg/L on the third day after surgery,followed by a gradual decrease and normal(3.92 ±1.13)mg/L on the 14th day after surgery.ESR was higher than normal(57.14 ±29.60)mm/h before surgery,and decreased(55 ±25.97)mm/h on the first day after surgery,and then gradually increased,reaching the peak(97.14 ±29.60)mm/h on the seventh day after surgery,followed by a slow decrease,and decreased to the preoperative level(55.14 ±16.62)mm/h on the 30th day after surgery.4.It was found that 6 patients with early infection around the prosthesis and 2 patients had recurrence within 5 days after surgery,both of which were higher than the normal range,and the maximum value was up to 22 x 109/L.Four cases of CRP continued to increase within 1 week after operation,with a maximum value of 86.4mg/L.All the six cases of ESR increased rapidly and were significantly higher than the normal range,reaching up to 220mm/h.5.In five days after in measuring points,to 10.0 x 109/L,WBC counts,CRP23.5 mg/L,ESR54.5 mm/h to measure threshold,the statistical analysis of patients with the infection has significant difference(P<0.05).Conclusions:1.The changes of white blood cell count,CRP and ESR in patients with unilateral total hip replacement for ischemic necrosis of femoral head were the same in the direct anterior approach and the posterolateral approach.CRP reached its peak 3 days after operation and decreased to normal range 2 weeks after operation.The ESR reached its peak 7 days after surgery and decreased to normal 1 month after surgery.There was no significant difference in the inflammatory indexes between the two approaches.2.The white blood cell count of patients with ankylosing spondylitis reached its peak on the first day after surgery,and decreased to normal 3 days after surgery.CRP reached its peak 3 days after operation and decreased to normal 2 weeks after operation.ESR was higher than the normal range before surgery,with a transient decrease on the first day after surgery,peak on the seventh day after surgery,and decreased to the preoperative level one month after surgery.3.The white blood cell count of rheumatoid arthritis patients reached the peak on the first day after surgery,and then decreased,but all of them were in the normal range before and after surgery.CRP reached its peak 3 days after operation and decreased to normal range 2 weeks after operation.ESR was higher than the normal range before surgery,with a transient decrease on the first day after surgery,reaching a peak on the seventh day after surgery,and falling to the preoperative level one month after surgery.4.The change trend of inflammatory markers in infected patients was different from that in non-infected patients.One or more inflammatory markers were significantly increased or increased again after the decrease.5.In this case,the recommended threshold of bone and joint association was taken as the measured value,and the cutoff point was taken as the fifth day after surgery,which was highly sensitive to the diagnosis of early infection. |
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