Objective To investigate the method and effectiveness of vacuum seal ing drainage (VSD) combined with debridement for treatment of deep infection after hip or knee replacement. Methods Between September 2006 and May 2010, 13 cases of deep infection after joint replacement surgery were treated, including 5 males and 8 females with an average ageof 62.5 years (range, 56-78 years). Infection occurred at 7 days to 1 year and 2 months (median, 14 days) after joint replacement surgery. The time from infection to admission was 8 days to 4 years and 6 months (median, 21 days). Purulent secretion with or without blood were observed in all patients; sinus formed in 5 cases; and unhealing of incision or drainage opening disunion were observed in 8 cases. The size of skin defect at secretion drainage or sinus opening site was 5 mm × 3 mm to 36 mm × 6 mm; the depth of drainage tunnel or sinus was 21-60 mm. The histopathological examination in 11 patients showed acute infection or chronic infection with acute onset in 10 cases, and tuberculosis in 1 case. In 6 cases of secretion culture, Staphylococcus aureus was isolated from 5 cases. After thorough debridement, wound irrigation was performed during the day and VSD during the night in 10 cases. VSD was merely performed in 3 cases. Results In 1 case after revision total hip arthroplasty, the wound bled profusely with VSD, then VSD stopped and associated with compression bandage, VSD proceeded again 3 days later with no heavy bleeding. All the patient were followed up 1 year to 4 years and 5 months (mean, 2 years and 11 months). Infection were controlled 7-75 days (mean, 43 days) after VSD in 10 cases. In these cases, prosthesis were reserved, no recurrent infection was observed, wound were healed, limb function were reserved. VSD was refused in 1 case because of hypersensitive of the pain at the vacuum site, infection control was failed and amputation at the thigh was proceeded. The effect was not evident in 1 case with tuberculosis infection, then the prosthesis was removed and arthrodesis was proceeded followed by complete union. In 1 case, infection was cured with VSD, recurrent infection happened after 9 months, antibiotic-impregnated cement spacer was used at end, and no recurrence was observed 1 year and 4 months later. Conclusion VSD combined with debridement can drainage deep infection sufficiently, promote wound healing, reduce recurrent infection rate, maximize the possibil ity of prosthesis preservation.
ObjectiveTo summarize the perioperative blood management strategies for joint arthroplasty. MethodsThe literature concerning preoperative, intraoperative, and postoperative blood management was reviewed and summarized. ResultsAt present, a variety of blood management and conservation strategies are available. Preoperative strategies include iron supplementation, erythropoietin (EPO), and preoperative autologous donation (PAD). Intraoperative options include acute normovolemic hemodilution (ANH), antifibrinolytics, and the use of a tourniquet. Postoperative strategies include the use of reinfusion systems and guided transfusion protocols. Preoperatively, administration of either simple EPO or a combination of EPO and PAD can be efficacious in anemic patients. Intraoperatively, tourniquet use and tranexamic acid can effectively control bleeding. Postoperatively, appropriate transfusion indications can avoid unnecessary blood transfusions. ConclusionPerioperative blood management strategies for joint arthroplasty should be integrated for the individual patient using a variety of ways to reduce perioperative blood loss and blood transfusion, and promote the rehabilitation of patients.
Objective To investigate the short-term effectiveness of Swanson artificial joint replacement in treating post-traumatic metacarpophalangeal joint stiffness. Methods Between August 2007 and May 2010, 11 cases (13 fingers) of metacarpophalangeal joint stiffness with soft tissue defects underwent Swanson artificial joint replacement. There were 7 males (9 fingers) and 4 females (4 fingers), aged 43 to 65 years with an average of 49 years. The involved fingers included 4 thumbs, 4 index fingers, 3 middle fingers, and 2 ring fingers. The types of injury included open and crush injury in 8 fingers, fracture of the metacarpophalangeal joint in 3 fingers, metacarpophalangeal joint severing in 2 fingers. The time from joint stiffness to hospitalization was 12 to 48 weeks (mean, 24 weeks). The joint activity was (136.82 ± 28.96)°. According to total active motion (TAM) assessment, included good in 1 finger, fair in 6 fingers, and poor in 6 fingers before operation. The activities of daily living were assessed by Sollerman score, which was 45.64 ± 11.04. The X-ray films and CT scan showed traumatic arthritis of the metacarpophalangeal joint. Results The incision healed by first intention. All patients were followed up 12 to 34 months (mean, 24.1 months). At last follow-up, the joint activity was (194.64 ± 28.86)°, showing significant difference when compared with preoperative value (t=25.214, P=0.000). According to TAM assessment, including excellent in 1 finger, good in 4 fingers, fair in 7 fingers, and poor in 1 finger. The Sollerman score was 67.45 ± 8.20 postoperatively, showing significant difference when compared with the preoperative score (t=10.470, P=0.000). X-ray examination showed no prosthesis fracture, periprosthetic fracture, or joint dislocation occurred at last follow-up. Conclusion Swanson artificial joint replacement can be appl ied to treat posttraumatic metacarpophalangeal joint stiffness, which can improve the joint activity and has satisfactory short-term effectiveness.
In order to evaluate the long-term effect of total hip replacement (THR) in patients with steroid-induced femoral head necrosis, 40 cases of 50 hips received THR patients were followed up for an average of 8.5 years after operation. Evaluation was carried act according to Harris score system. In these cases, average score was seventy-five points. Revision rate among them was 2% after four years and 18% after five to eight and a half years, with as overall rate of 20%. It was found that the main reason for revision was looseness of the prosthesis. In this follow-up, it showed that besides foreigen body reaction, abnormal osseous remodelling was the main factor in long-term failure of this arthroplasty. It was also proved that it was a good selection to perform cemented total hip replacement in younger patients, which could improve living quality.
ObjectiveTo summarize the research progress in artificial metacarpophalangeal joint and interphalangeal joint prostheses.MethodsThe research literature on artificial metacarpophalangeal joint and interphalangeal joint prostheses at home and abroad was reviewed and summarized from anatomy, prosthesis design, and material development.ResultsThe artificial joint replacement can correct deformity, relieve pain, and improve function immediately. In the past 50 years, many researches have focused on the design and material of prostheses and surgical technique of joint replacement. There are three types of prostheses, including hinged limit-type-prosthesis, semi-limit-type-prosthesis, and non-limit-type-prosthesis. The prostheses have their own advantages and disadvantages, the long-term effectiveness of joint replacement is not ideal.ConclusionThe metacarpophalangeal joint and interphalangeal joint prostheses with more anatomical structure and biocompatible materials are needed.
Objective To summarize the effect of biofilm (BF) on the occurrence of prosthetic joint infection (PJI). Methods The domestic and abroad original l iterature in recent years about the relationship between BF and PJI was reviewed. Results Infection is a critical compl ication for prosthetic joint replacement. Basic research showes one of the reasons for PJI is BF. After adherence of the bacteria to the surface of prosthetic joint, BF forms through a series of regulation andcontrol system. And it lead to the occurrence of PJI. Recently a lot of progress have been made in the research fields of BF related PJI, which have covered aetiology, diagnosis, treatment, and prevention. Different studies show that BF has close relationship with PJI. Conclusion BF is proved to have close relationship with PJI. It is important on cl inical significances to diagnose, treat, and prevent PJI.
Doctor-patient shared decision making is an expansion and extension of the patient-centered concept, which emphasizes communication and collaboration between doctors and patients in making decisions, focuses on patients, needs, enhances communication and exchange between doctors and patients, and improves the status of patients in medical decision making. This paper reviews the concept, domestic and international research overview, advantages, and application of doctor-patient shared decision making in hip and knee arthroplasty, and discusses the future research directions, in order to provide a reference for the application of shared decision making between doctors and patients in hip and knee arthroplasty in China.