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Objective: To investigate the clinical effects of one-stage revision combined with intra-articular infusion of vancomycin in the treatment of chronic prosthetic joint infection (PJI) caused by Enterococcal . Methods: From May 2013 to June 2020,the clinical data of 9 patients (2 males and 7 females) with chronic Enterococcal PJI treated with one-stage revision using intra-articular infusion of vancomycin at Department of Orthopaedics,First Affiliated Hospital of Xinjiang Medical University were retrospectively analyzed,including 8 hips and 1 knee.A total of 9 patients with age of (63.9±11.7)years (range:43 to 76 years) were included, and the body mass index was (23.6±4.3)kg/m 2 (range:18 to 30 kg/m 2 ).There were 6 cases with antibiotic history and 5 cases with sinus tract.The joint fluid,infected tissue around the prosthesis and ultrasonic shock fluid of the prosthesis were collected during operation for microbial culture identification and drug sensitivity test.After thorough debridement of the infected site and removal of the infected prosthesis,a new prosthesis was implanted,then the drainage tube in the operation area was placed.After surgery,vancomycin(1.0 g,q12 h) was combined with intra-articular vancomycin(0.5 g,qd) in monomicrobial PJI,and vancomycin(1.0 g,q12 h) was combined with intra-articular vancomycin (0.5 g,qd) and imipenem/meropenem (0.5 g,qd),and the interval between the two drugs was 12 hours in polymicrobial PJI.Hip and knee functions were evaluated by Harris Hip Score or Knee Society Score(KSS),respectively.The comparison of hip function scores before and after operation was performed by paired t -test. Results: All patients were followed up for (60±39)months(range:24 to 110 months).Two cases were infected with Enterococcus faecium and 7 cases were infected with Enterococcus faecalis .There were 7 cases of monomicrobial infection and 2 cases of polymicrobial infection.Erythromycin(5/9),tetracycline(4/9),ciprofloxacin and β-lactam antibiotics(3/9) were the top three antibiotics in Enterococci resistance rate.The sensitive antibiotics for Enterococcal were vancomycin,linezolid and tigecycline.The average duration of intravenous antibiotics was (14±1)days (range:13 to 17 days),and the average duration of antibiotics in articular cavity was (15±2)days(range:11 to 20 days).Mean duration of oral antibiotic use after discharge was (2±1)months(range:1 to 3 months).One case of polymicrobial PJI treatment failed,with a failure rate of 1/9.At last follow-up,the Harris score of patients with hip PJI increased from (43±6)points to (84±6)points( t =-11.899, P <0.01). KSS score of knee function was improved from 33 point pre-operatively to 85 point post-operatively;overall function score was improved from 35 point pre-operatively to 80 point post-operatively.During the treatment,no formation of sinus tract of the hip joint caused by a catheter,skin necrosis at the knee puncture site or leakage of joint fluid;no complications such as deep vein thrombosis and pulmonary embolism occurred. Conclusions: One-stage revision combined with intra-articular infusion of vancomycin can achieve acceptable infection control rate and joint function in patients with chronic Enterococcus PJI.However,the treatment of polymicrobial PJI still needs to be further verified.

Prosthetic joint infection is one of the most serious complications after artificial joint replacement.Accurate diagnosis and proper standardized treatment are the keys to improve the cure rate of prosthetic joint infection,reduce the rate of recurrence and disability,and restore limb function.Regarding the diagnosis and treatment of prosthetic joint infection,although relevant research has progressed rapidly in recent years,there are still many problems that have not been well understood and explained,and there are still big differences and controversies in many aspects.This has brought a lot of confusion to clinicians during their daily practice.In order to make the diagnosis and treatment of prosthetic joint infection in China more standardized,a group of domestic experts in related fields was organized by the Joint Surgery Committee of the Chinese Orthopaedic Association to search the literature and integrate expert opinions,and compiled the "Guidelines for the diagnosis and treatment of prosthetic joint infection".Those most important and clinically concerned issues are elaborated,including the diagnostic criteria, standardized diagnostic algorithm,proper application of important tests,treatment principles,and the correct selection of various treatment options.Targeted and actionable recommendations are proposed.This guideline is expected to provide references for domestic colleagues in the diagnosis and treatment of prosthetic joint infection.

BACKGROUND: Taohong Siwu Decoction has a good effect in the treatment of periprosthetic infection after joint replacement, and can improve the function of joint movement. However, most present studies focus on the antibacterial effect of single drug and its components in the prescription, and there is little research on the compound and other mechanisms. OBJECTIVE: To explore the mechanism of Taohong Siwu Decoction in the treatment of periprosthetic joint infection. METHODS: Ingredients and target genes of Semen Persicae, Carthami Flos, Rehmanniae Radix Praeparata, Paeoniae Radix Alba, Angelicae Sinensis Radixand and Chuanxiong Rhizoma were screened by Traditional Chinese Medicine Systems Pharmacology Database and Analysis Platform. Periprosthetic joint infection-related target genes were obtained from the human gene database (GeneCards). Cytoscape3.7.2 was used for constructing a “Drug-Ingredient-Target-Disease” network. The key target genes were introduced into the STRING to construct protein-protein interaction network. We analyzed the mechanism by Kyoto Encyclopedia of Genes and Genomes and Gene Ontology biological enrichment analysis. RESULTS AND CONCLUSION: (1) Totally 15 active components, such as quercetin, luteolin and kaempferol, were screened from Taohong Siwu Decoction, which acted on 34 key genes, such as vascular endothelial growth factor A, tumor necrosis factor, and interleukin-6. (2) Gene Ontology function enrichment showed that the biological process and function of Taohong Siwu Decoction were concentrated in positive regulation of biological process, response to chemical stimulus, response to stress, and regulation of apoptosis. (3) Kyoto Encyclopedia of Genes and Genomes pathway enrichment showed that the treatment of periprosthetic joint infection by Taohong Siwu Decoction mainly involved pathways in cancer, AGE-RAGE signaling pathway, fluid shear stress and atherosclerosis, inflammatory bowel disease and cytokine-cytokine receptor interaction pathway. (4) Through the study of network pharmacology, it is found that Taohong Siwu Decoction could treat periprosthetic joint infection by inhibiting bacterial growth and improving hemorheology, which provided a preliminary theoretical basis for the application of “activating circulation and removing blood stasis” in periprosthetic joint infection and a new idea for subsequent experiments. [ABSTRACT FROM AUTHOR]

Objective To analyze the bacteriological characteristics in the patients with prosthetic joint infection after artificial joint replacement in Europe so as to provide reference for its clinical diagnosis and treatment. Methods The medical literatures about prosthetic joint infection (hip，knee，shoulder) after artificial joint replacement in Europe from 2011 to 2016 were retrieved. The incidence of prosthetic joint infection was statistically analyzed. Results Thirty articles met the inclusion criteria， in the cases of knee and hip infection，the majority were coagulase-negative staphylococci and Staphylococcus aureus，while Propionibacterium was most common in shoulder infection. Conclusion The key for successfully preventing and treating prosthetic joint infection lies in the multiple disciplinary team collaboration， the microbiologists， infectious disease specialists， orthopedists and traumatic surgeons jointly adopt the preventive measures and diagnosis， strictly accord with bacterial culture and drug susceptibility test results， avoid to increase the drug resistance， rationally select antibiotics and combine with surgical operation for finally realizing to eradicate infection and preserve joint function without any pain. [ABSTRACT FROM AUTHOR]

Objective: To summarize the recent progress in prevention of prosthetic joint infection (PJI) so as to provide clinical references., Methods: The publications concerning the etiology and surgical management of PJI were reviewed, analyzed, and summarized., Results: The prevention of PJI is related to preoperative, intraoperative, and postoperative aspects of PJI, comprehensive treatment is considered to be the most common method for PJI., Conclusion: These prevention strategies that may be utilized in all phases of perioperative care, a multifaceted approach to the patient undergoing total joint replacement will have the greatest positive effect.

Objective: To provide the evidence for diagnosis and treatment of the complication by describing the distribution and drug sensitivity of pathogens in patients with prosthetic joint infection (PJI) after primary total knee arthroplasty (TKA)., Methods: Between January 2003 and June 2013, 65 cases (65 knees) with PJI after primary TKA were treated. There were 28 males and 37 females with an average age of 63.2 years (range, 37-80 years). The median interval between PJI and primary TKA was 2.8 years (range, 2 weeks to 11 years), including 29 left knees and 36 right knees. Prosthesis loosening could be found in 27 cases by X-ray examination. The average value of C-reactive protein and erythrocyte sedimentation rate was 37.4 mg/L (range, 12.5-197.0 mg/L) and 63.2 mm/1 h (range, 29.3-73.8 mm/l h) respectively. Preoperative and intraoperative synovial fluid as well as intraoperative tissue samples should be submitted for aerobic and anaerobic culture. The four types of infections were made according to the Tsukayama et al. classification standards., Results: The patients were all diagnosed as having PJI. There were 5 (7.69%) type I infections, 4 (6.15%) type IIA, 8 (12.31%) type IIB, 3 (4.62%) type III, and 45 (69.23%) type IV according to the Tsukayama et al. classification standard. Bacterial culture results were negative in 12 cases and positive in 53 cases, the main pathogen was Gram-positive cocci (39/53). The most common organism identified was Coagulase-negative Staphylococcus (24/53) followed by Staphylococcus Aureus (12/53). Resistant bacterium accounted for 61.11% (22/36) of Staphylococcus. These bacterium were all sensitive to vancomycin, linezolid, meropenem, and fluconazole; and highly resistant to erythrocin, penicillin, and cefoxitin. The main pathogenic bacteria of Coagulase-negative Staphylococcus and Staphylococcus aureus had highest resistant rate to penicillin., Conclusion: Gram-positive cocci is the main pathogen in patients with PJI after primary TKA, which is highly resistant to penicillin and macrolides. Antibiotic treatment of this complication should be based on the result of drug sensitivity test, vancomycin and linezolid may be used before the result of drug sensitivity test. It is important to pay attention to rare and multiple resistant bacteria.

Objective: To explore the clinical characters and histopathologic differences between patients with culture-positive and culture-negative prosthetic joint infection (PJI)., Methods: Between January 2012 and July 2013, 66 PJI patients in accord with diagnostic criteria were enrolled. According to the results of preoperative aspiration and intraoperative cultures, the patients were divided into culture-negative group (CN group, n = 21) and culture-positive group (CP group, n = 45). There was no significant difference in gender, age, height, weight, and body mass index between 2 groups (P > 0.05). Preoperative C reactive protein (CRP), erythrocyte sedimentation rate (ESR), and prosthesis survival time were compared between 2 groups. Intraoperative frozen sections and paraffin sections were both performed to identify infections, and histological typing was performed according to Morawietz's methods., Results: The preoperative CRP was (1.29 +/- 1.84) mg/dL in CN group and (5.08 +/- 9.57) mg/dL in CP group, showing significant difference (t = 2.094, P = 0.038). The preoperative ESR was (22.86 +/- 28.42) mm/1 h in CN group and (36.74 +/- 31.26) mm/1 h in CP group, showing significant difference (t = 7.761, P = 0.000). The median survival time of prosthesis was 72 months (range, 8-504 months) in CN group and 25 months (range, 15 days-300 months) in CP group, showing significant difference (U = 2.231, P = 0.026). Morawietz's histological typing results showed that 2 cases were rated as type I, 7 cases as type II, and 12 cases as type III in CN group; 6 cases were rated as type I, 25 cases as type II, 13 cases as type III, and 1 case as type IV in CP group. The positive culture rate was 68.18% (45/66), and pathogenic bacteria was dominated by Staphylococcus, accounting for 68.89%., Conclusion: The patients with culture-negative PJI have slow onset and mild inflammatory response, so comprehensive diagnosis should be made based on pathological detection, laboratory examination, and intraoperative cultures.

Objective: To summarize the effect of biofilm (BF) on the occurrence of prosthetic joint infection (PJI)., Methods: The domestic and abroad original literature in recent years about the relationship between BF and PJI was reviewed., Results: Infection is a critical complication for prosthetic joint replacement. Basic research shows 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 and control 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 clinical significances to diagnose, treat, and prevent PJI.

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BACKGROUND: The diagnosis of periprosthetic joint infection is one of the difficulties and key points in clinical research. Joint puncture is a commonly used method in the preoperative diagnosis of periprosthetic joint infection, because it is simple and easy to spread. In recent years, synovial fluid examinations have been gradually used in clinical diagnosis, but there remain many disputed issues. OBJECTIVE: To summarize latest research progress of synovial fluid analysis in the diagnosis of periprosthetic joint infection in and outside China. METHODS: Publications in English and Chinese from 2008 to 2018 were searched by the first author for studies regarding joint puncture in the diagnosis of periprosthetic joint infection from the electronic databases of PubMed, Web of Science, and CNKI using the following keywords: periprosthetic joint infection, prosthetic joint infection,synovial fluid, joint puncture, and articular puncture. Five hundred and eighty-four articles were identified by the literature search. By reading the literature title, abstract and full text, 52 studies were included in our review paper. RESULTS AND CONCLUSION:(1) Preoperative joint puncture is an indispensable part of the diagnosis of periprosthetic joint infection.(2) Until now, there is no single test that can diagnose periprosthetic joint infection alone; however, combining several examination methods can improve diagnostic accuracy.(3) Joint puncture under ultrasonic guidance has several advantages over fluoroscopy and standard methods.(4) Although several new methods have certain advantages in the diagnosis of periprosthetic joint infection, conventional testing of blood culture bottles and leukocyte counts still have an irreplaceable role in the diagnosis of periprosthetic joint infection. [ABSTRACT FROM AUTHOR]

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