Analysis And Treatment Of The Risk Factors Of The Prosthetic Joint Infection After The First Hip And Knee Replacement

ObjectiveThe risk factor analysis and long-term follow-up of patients with Prosthetic Joint Infection after the first hip-knee joint replacement provide a basis for reducing the postoperative infection rate and improving the quality of life of patients.MethodsReview the data of all patients who received periprosthetic infection after the first hip-knee joint replacement from September 2013 to January 2019 in our hospital.Patients'infections were treated in 34 patients(19 males,15 females,20 hips,14 knees)after hip-knee joint replacement with periprosthetic infection.The 34 patients were selected as the experimental group,and 68 patients without infection after hip-knee replacement during the same period were randomly selected according to the 1:2 ratio as the control group.Identify the infection status,analyze the cause,diagnosis,treatment,and pathogen culture results of the patients in the case group to find out the possible factors related to the disease,including the patient's own factors before surgery,perioperative factors and postoperative factors,including Age,gender,BMI,diabetes,liver and kidney dysfunction,history of hormone use,anemia,hypoproteinemia,operation time,surgical site,intraoperative bleeding,perioperative allogeneic blood transfusion,postoperative drainage,postoperative antibiotic use time And hospitalization time,statistical analysis of collected data and extracted pathogen culture results,and drug sensitivity tests were performed to determine the risk factors of infection around the prosthesis after hip-knee replacement.All PJI patients admitted in our hospital undergo two-stage revision surgery.The revision surgery includes the surgical period,the transition period,and the second revision period.All patients are followed up in the outpatient clinic.The patients' recovery status is based on the Harris score system and the HSS score system.Record and evaluate.ResultsUnivariate analysis showed that diabetes,long-term use of hormones and immunosuppressants,BMI,preoperative anemia,preoperative hypoalbuminemia,operation time,and allogeneic blood transfusion were important influencing factors for periprosthetic infection after hip and knee replacement(P<0.05);Multivariate Logistic regression analysis showed that BMI is large,preoperative hypoalbuminemia,preoperative anemia,long-term use of hormones and immunosuppressants,long operation time,large postoperative drainage,and long hospital stay are hip and knee Independent risk factors for periprosthetic infection after joint replacement(P<0.05);Among 34 patients with periprosthetic infection after hip-knee joint replacement,28 patients were clearly detected with pathogenic bacteria,and the culture positive rate was 82.4%.Among them,19 were Gram-positive bacteria,accounting for 67.9%.There were 9 Gram-negative bacteria,accounting for 32.1%.Twenty patients with periprosthetic infection after hip replacement,65.0%of Gram-positive bacteria infection,14 patients with periprosthetic infection after knee replacement,78.6%of Gram-positive bacteria infection,hip The rate of Gram-positive bacteria infection in patients with periprosthetic infection after replacement was not statistically different from the rate of Gram-positive bacteria in patients with periprosthetic infection after knee replacement(P>0.05);20 patients with hip PJI were admitted at admission The Harris score of the patients before surgery was 41.2±10.5(25-53 points),and the preoperative HSS score of 14 patients with knee PJI was 40.5 ± 5.1(20-53 points),indicating that the hip and knee functions were poor.Before revision surgery,20 patients with hip PJI had a Harris score of 58.7±11.5(36-77 points),and 14 patients with knee PJI had an HSS score of 51.5 ± 3.6(42-63 points)before operation,showing hip and knee joints.The function is significantly improved than before.Six months after surgery,20 patients with hip PJI had a Harris score of 87.7 ±8.5(71-97 points)before surgery,and 14 patients with knee PJI had an HSS score of 85.5± 3.8(80-93 points)before surgery,showing hip and knee joints.Functionality continues to improve from before.No complications such as fractures,periprosthetic infections of the hip and knee joint occurred again in all patients.ConclusionLarge BMI,preoperative hypoproteinemia,preoperative anemia,long-term use of hormones and immunosuppressants,long operation time,large postoperative drainage,and long hospital stay may lead to infection around the prosthesis after the first hip and knee joint replacement Among them,Gram-positive bacterial infections are the main causes.The second-stage revision surgery can significantly control the infection of PJI patients,improve joint function,and improve the quality of life of PJI patients.The second-stage revision surgery treats PJI,and the second stage is performed 3 months after the first surgery.Revision surgery,the surgery effect is obvious.