2008/12/23

Chart No

NameAge/Sex

Diagnosis Operation

Mortality &

Morbidity

0000000

陳 00

1.S/P left bipolar prosthesis with acetabular wear 2.Asthma3.Gastroesophageal Reflux Disease 4.Duodenal ulceration5.GB stone 6.Anxiety state 7.HBV

97/11/18 revision THR

infection

00000000

潘 00

1. Right femoral subtrochanteric fracture s/p ORIF on 12/8

2. Right radio-ulna fracture s/p ORIF on 12/12

3. Grade II liver laceration 4. Right thigh contussion injury

97/12/8 DHS for right femur97/12/12 plate for right forearm

post-OP wound infection and massive discharge

00000000

陳 00

1. left femoral neck fracture 2. T12 compression fracture3. hypertension4. scabies

97/12/10 Moore

infection

Chart No

NameAge/Sex

Diagnosis Operation

Mortality &

Morbidity

0000000

張 001. right intertrochanteric fracture

post DHS and cannulated screw 10/28

2. UTI3. hypertension

97/12/15 THR and cable wire fixation

revision

00000000

許 001. Right hip prosthesis cup

loosening 2 years ago at LMD2. Gout history

97/11/28 revision cup

Cup failure

00000000

陳 00

1. left femoral supracondylar fracture with nonunion

2. HTN3. hepatitis C with cirrhosis

97/12/19 condylar plate

nonunion

00000000

黃 00

1. right intertrochanteric fracture post dynamic hip screw, with plate failure and nonunion, in this August

2. UTI

97/12/05 DHS

revision

OKU 9

Discussion

Arthroplasty: infection 1~2 % S. aureus, S epidermidis Classification:

Type I positive culture after surgical revision

Type II positive culture 30 days after OP

Type III hematogenous spread Type IV chronic or late infection

Diagnosis:

Pain: night pain / rest pain Arthrocentesis:

1.7X109/L or 65% > blood; 94-97% sen, 88-98% spe

ESR, CRP, IL-6, blood culture, WBC/DC

Plain X-ray 99mTc / leukocyte scanning

Diagnosis establish

1. Growth of the same organism discovered via two or more diagnostic methods

2. Acute inflammation on histology3. Gross purulence4. Actively discharging sinus tract

Antibiotics only: Poor medical condition, unable to remove

prosthesis Pathogen low virulence / susceptible to

oral Anti Anti has fewer adverse reactions Prosthesis is not loose

40/225 (18%) TKR; 62/261 (24%) TKR success treated by antibiotics

4~6 weeks than shaft to oral anti

OPEN debridement Acute postoperative time frame (type II) Hematogenous spread (type III)

Criteria: < 2 weeks duration G(+) organism No sinus tract / drainage No loosening of the prosthesis

Revision (one stage / two stage) Delayed reimplantation (after 6

weeks IV antibiotics treat / 3~4 weeks anti + anti cement): good result