Clinical study of treatment of early prosthetic joint infection after total hip arthroplasty by debridement,antibiotics,and implant retention combined with local perfusion of vancomycin
Objective To investigate the clinical efficacy of treatment of early prosthetic joint infection(PJI)after total hip arthroplasty(THA)with debridement,antibiotics,and implant retention(DAIR)combined with local perfusion of vancomycin into hip joint.Methods A total of 21 patients with early PJI after the initial THA who received DAIR combined with local perfusion of vancomycin into their joint cavity in Department of Orthopaedics,Huangshi Central Hospital from July 2018 to May 2022 were enrolled.Among them,there were 11 males and 10 females,aged(67.05±11.04)years,all patients with PJI within 3 weeks after the initial THA,and the follow-up time was(18.95±4.07)months.The operation was performed by a fixed medical team,all operated by the same doctor,and DIAR surgery was used for debridement.Sensitive antibiotics were given intravenously within 2 weeks after surgery.The patients with culture negative could be given vancomycin intravenously,0.5 g of which was given intravenously every 12 hours,and vancomycin solution was injected into the joint cavity once every 2 days(the protocol was 0.5 g of vancomycin powder dissolved in 60 ml of normal saline and pushed into the joint cavity by self-irrigating tube under sterile conditions).The joint fluid was retained and drug concentration in the joint cavity was monitored.Intravenous medication for 2 weeks was followed by oral antibiotics for 4 weeks.The Visual Analogue Scale(VAS)score and Harris Hip Score(HHS)were used to evaluate the pain and hip joint function.The white blood cell count(WBC),erythrocyte sedimentation rate(ESR),and C-reactive protein(CRP)were used as infection indicators,and differences in their levels before surgery and at the last follow-up were determined by paired t-test.Results A total of 21 patients were enrolled;their age was(67.05±1 1.04)years old and 11 of them were male.All the patients were followed up for over 12 months,with a follow-up period of(18.95±4.07)months.The overall infection control rate was 90.5％(19 cases were cured and 2 cases failed).At the last follow-up,the VAS score was decreased compared with that before surgery[(1.62±0.67)points vs.(5.86±1.06)points],the HHS was increased compared with that before surgery[(77.92±7.72)points vs.(41.30±7.77)points],and the WBC,ESR,and CRP levels were all decreased compared with those before surgery[(5.04±0.86)x109/L vs.(10.62±1.02)x109/L,(19.00±8.08)mm/h vs.(65.57±18.00)mm/h,(5.86±1.80)mg/L vs.(57.05±19.16)mg/L],with statistically significant differences(t=13.766,-16.159,17.654,12.610,and 12.570,all P＜0.001).Conclusion DAIR combined with local perfusion of vancomycin into joint cavity can effectively control the hip joint infection and relieve the hip joint pain in patients with early PJI after THA.
VancomycinLocal perfusionProsthetic joint infectionTotal hip arthroplasty
万方数据
维普
