Factors influencing the alteration of inflammatory indicators in joint fluid following one-tage revision surgery for periprosthetic hip joint infection
10.3760/cma.j.cn121113-20240506-00265
- VernacularTitle:髋关节假体周围感染一期翻修术后关节液炎性指标变化的影响因素
- Author:
Yaozong HOU
1
;
Yicheng LI
1
;
Li CAO
1
;
Xiaogang ZHANG
1
Author Information
1. 新疆医科大学第一附属医院关节外科，乌鲁木齐 830054
- Publication Type:Journal Article
- Keywords:
Arthroplasty, replacement, hip;
Reoperation;
Synovial fluid;
Inflammation;
Risk factors
- From:
Chinese Journal of Orthopaedics
2024;44(24):1573-1580
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To analyze the factors influencing the alteration of inflammatory indicators in joint fluid following one-stage revision of periprosthetic joint infection (PJI).Methods:A total of 104 patients who underwent one-stage revision of PJI after primary hip arthroplasty at Department of Joint Surgery, the First Affiliated Hospital of Xinjiang Medical University from June 2017 to June 2023 were retrospectively analyzed. There were 59 males and 45 females, aged 60.57±13.41 years (range, 27-89 years). According to the results of joint fluid inflammation indicators on the 14th day after surgery, the patients with both white blood cell (WBC) count and polymorphonuclear cells (PMN) ratio higher than the median were defined as the fluctuation group, and the rest were the non-fluctuation group. There were 31 cases in the fluctuating group, aged 61.06±14.77 years (range, 28-89 years), and 73 cases in the non-fluctuating group, aged 60.36±12.90 years (range, 27-86 years). The age, sex, body mass index (BMI), previous comorbidities, previous surgical history, bacterial virulence, preoperative sinus tract, antibiotic allergy history, fever during postoperative medication, urine bacteria, preoperative erythrocyte sedimentation rate (ESR), preoperative C-reactive protein (CRP), synovial fluid WBC count and PMN proportion on postoperative day 1, 3, 5, 7, 9 and 14 were recorded. The variables with statistically significant differences in the above indicators were included in binary logistic regression analysis to determine the independent risk factors leading to the fluctuation of synovial fluid inflammatory indicators.Results:The WBC count of synovial fluid of 104 PJI patients was 2,434×10 6 (1,110×10 6, 4,266×10 6)/L and the proportion of PMN was 79.5%(64.3%, 90.0%) 14 days after operation. A total of 31 patients (fluctuation group) had higher joint fluid WBC count 4,824×10 6 (3,811×10 6, 11,485×10 6)/L and PMN proportion 90.1%(89.6%, 94.3%) than the median on the 14th day after operation. The remaining 73 patients were included in the non-fluctuation group, and the synovial fluid WBC count and PMN proportion were 2,434×10 6 (1,170×10 6, 4,222×10 6)/L and 79.5%(64.8%, 90.0%), respectively, 14 days after operation. There were no significant differences in age, body mass index, previous comorbidities, previous surgical history, preoperative sinus tract, antibiotic allergy history, postoperative fever or urine bacteria between the two groups ( P>0.05). There were significant differences in sex ratio and bacterial virulence between the two groups ( P<0.05). Sex ratio and bacterial virulence were included in a binary logistic regression analysis, which showed that sex being male ( OR=4.319, P=0.005) and joint fluid microbiological culture results being weakly virulent ( OR=7.529, P=0.036) were independent risk factors for the fluctuation of synovial fluid inflammatory indicators after primary revision of hip PJI. Conclusion:Weak virulence of pathogens and male gender are independent risk factors for the fluctuation of synovial fluid WBC count and PMN proportion after one-stage revision of hip PJI.
