OBJECTIVE: To study the distribution and drug resistance of pathogens causing periprosthetic infections after hip and knee arthroplasty, and to formulate prevention and treatment strategies for drug-resistant bacteria. METHODS: The data of 146 cases of periprosthetic infection after primary hip and knee arthroplasty from 2010 to 2015 were collected, including 111 cases of periprosthetic infection after hip arthroplasty and 35 cases of periprosthetic infection after knee arthroplasty. The culture positive rate, pathogenic bacteria composition and drug resistance rate were counted over the years, and the change trend of pathogen distribution and drug resistance was analyzed. RESULTS: One hundredand eight strains of pathogenic bacteria were detected in 146 cases, and the positive rate of culture was 73.97%. Gram positive bacteria accounted for 55.48%, Staphylococcus epidermidis and Staphylococcus aureus accounted for 25.34% and 15.07% respectively. Gram negative bacteria accounted for 13.01%, including Enterobacter cloacae, Pseudomonas aeruginosa and Escherichia coli. There were 4 cases of Mycobacterium tuberculosis infection and mixed infection. The results of culture over the years showed that the constituent ratio of Gram positive bacteria had an increasing trend, fluctuating from 39.13% to 76.47%. The results of drug sensitivity showed that the pathogens were highly resistant to β-lactams, quinolones, clindamycin and gentamicin, and the drug resistance rate was increasing, but it was still sensitive to rifampicin, nitrofurantoin, tigecycline, linezolid and vancomycin. CONCLUSION Gram positive bacteria are the main pathogens of periprosthetic infection, and the proportion is increasing gradually.The pathogens have high resistance to many kinds of antibiotics, and the resistance rate is still increasing. To strengthen the monitoring of the distribution and drug resistance of pathogenic bacteria is helpful to grasp its change trend and formulate targeted prevention and control strategies.
Anti-Bacterial Agents/therapeutic use* ; Arthroplasty, Replacement, Knee/adverse effects* ; Drug Resistance ; Drug Resistance, Bacterial ; Gram-Positive Bacteria ; Microbial Sensitivity Tests ; Retrospective Studies

Objective To discuss the indications,feasibility and safety of fluoroscopy-guided retrieval of tracheal tubular metallic stents.Methods Between January 2010 to December 2014,fluoroscopy-guided retrieval of tracheal tubular metallic stent was performed in 45 patients.The stents included 36 covered stents and 9 naked stents.The mean retention time of the covered and naked stents was (3.2±0.7) months and (2.5± 1.2) months respectively.Before the retrieval of the 36 covered stents,granulation tissue hyperplasia in different degrees was observed at both ends of 15 stents,and stent fracture was found in 3 stents.Granulation tissue hyperplasia was seen in all 9 naked stents.Among the 9 naked stents,5 stents were completely embedded in the tracheal submucosal area,and 2 stents were fractured.Results Of the 45 stents,41 stents were successfully retrieved (success rate of 91.1％),including 34 covered stents (94.4％,34/36) and 7 naked stents (77.8％,7/9).Of the 41 patients whose stents were successfully retrieved,massive hemoptysis occurred in 4 patients with a mean bleeding amount of 100 ml,tracheal mucosa tear was detected in 5 patients,emergency airway stent implantation because of tracheal collapse after stent retrieval was needed in one patient,and emergency surgical suture of the trachea due to tracheal rupture was carried out in one patient.No procedure-related death occurred.Conclusion The indications of fluoroscopy-guided retrieval of tracheal tubular metallic stents include stent fracture,local excessive proliferation of granulation tissue or tumor tissue that causes tracheal restenosis,temporary tracheal stent placement for benign tracheal stenosis,intolerance to stent implantation,etc.The technique of fluoroscopy-guided retrieval of tracheal tubular metallic stent is relatively safe and less invasive;this technique can solve the complications induced by long-term retention of the stents.

OBJECTIVETo analyze the incidence and anatomic distribution of venous thrombosis after total hip and knee arthroplasty by using the data of the patients with primary total hip and knee replacement.

METHODSFrom December 2013 to December 2014, total hip and knee arthroplasty were performed in 1 686 patients, of which 928 were THA and 758 were TKA. Before and after discharge, all patients were routinely performed double lower limb vein color Doppler ultrasound, the conventional use of anti fibrinolytic drugs, postoperative anticoagulation for 14 d. The types and distribution of thrombosis after operation were statistical analysis.

RESULTSAmong 928 cases of primary total hip arthroplasty, there were 30 cases of thrombosis, 27 cases of isolated muscle vein thrombosis, followed by the involvement of the anterior or posterior tibial vein thrombosis, no central thrombosis. Among 758 cases of primary total knee arthroplasty, there were 87 cases of thrombosis, 81 cases peripheral thrombosis, 4 cases of thrombus of center type, the remaining 2 cases for mixed thrombus;74 patients with thrombosis involving a single vein, 65 cases involved muscle vein, 4 cases of femoral vein, 3 cases of posterior tibial vein, 2 cases of superficial vein; 13 cases of thrombosis involving multiple veins, involving muscle vein, posterior tibial veins, the peroneal veins and popliteal vein in 2 or 3 branches. The comparison results showed that the incidence of thrombosis after total knee arthroplasty was higher, the difference was statistically significant (<0.001), and more prone to central thrombosis and multiple venous involvement.

CONCLUSIONSThe incidence of thrombosis in patients with primary hip and knee replacement is low, and the incidence and anatomic distribution of the patients with primary hip and knee replacement are different.

OBJECTIVETotal hip arthroplasty (THA) and hemiarthroplasty (HA) are effective methods currently used to treat femoral neck fracture in elderly patients, but the two options remain controversial in patients over 70 years old. The main purpose of our study was to determine whether THA or HA is a superior treatment of femoral fractures involving a displaced neck in patients who are over 70 years of age.

METHODSA computer-based online search of Medline (1970-2011), PubMed (1977-2011), and the Cochrane Central Register of Controlled Trials (2002-2011) was conducted. Six relevant randomized controlled trials with a total of 739 patients were included for the final analysis. The analysis was performed with software RevMan 5.0.

RESULTSWe found that compared with THA, HA needed shorter average time and lost less blood. While over the long-term follow-up, THA patients exhibited significantly less pain and better function and were less likely to require a revision hip surgery. Postoperative infection was equally common among HA and THA patients.

CONCLUSIONSThe significant differences in outcomes suggest that THA is a valuable treatment option for active elderly hip fracture individuals. However, patients who are older, impaired or institutionalized benefit from HA.

Arthroplasty, Replacement, Hip ; Femoral Neck Fractures ; surgery ; Hemiarthroplasty ; Humans ; Postoperative Complications ; Reoperation

OBJECTIVETo explore the technique and clinical results of close manipulative reduction and minimally invasive percutaneous plate osteosynthesis (MIPPO) for the treatment of tibial fractures in the middle and distal segment.

METHODSFrom Jan. 2005 to Dec. 2009, 40 patients with tibial fractures in middle and distal segment were treated with close manipulative reduction and MIPPO fixation, including 28 males and 12 females with an average age of 54 years old (ranging from 21 to 76). According to AO fractures classification for the tibial fractures in the middle and distal segment, there were 26 cases of type A, 8 of type B, 6 of type C.

RESULTSAll patients were followed up for 12 to 24 months (averaged 18 months). All the fractures gained bone healing, and the time required for the bony union ranged from 3 to 18 months (averaged 4 months). The patients were evaluated with respect to functional recovery according to Mazur Grating System for the ankle. The aggregate score was 96.67 +/- 3.91, involving pain 48.59 +/- 2.28, hills up 2.95 +/- 0.22, hills down 2.85 +/- 0.37, stairs down 2.92 +/- 0.35, run score 4.95 +/- 0.32, plantar flexion score 4.62 +/- 0.54, dorsiflexion score 4.13 +/- 0.61. The clinical results were excellent in 36 cases, good in 3 and fair in 1.

CONCLUSIONClose manipulative reduction and MIPPO fixation is a good method for the treatment of the tibial fractures in the middle and distal segment.

Adult ; Aged ; Bone Plates ; Female ; Follow-Up Studies ; Fracture Fixation, Internal ; instrumentation ; Humans ; Male ; Medicine, Chinese Traditional ; methods ; Middle Aged ; Musculoskeletal Manipulations ; methods ; Recovery of Function ; Retrospective Studies ; Skin ; Tibial Fractures ; diagnostic imaging ; physiopathology ; surgery ; therapy ; Tomography, X-Ray Computed ; Young Adult

OBJECTIVETo evaluate clinical and radiographic results and influencing factors of hybrid total hip arthroplasty (THA).

METHODSTotally 126 patients (135 hips) from January 1999 to December 2001 accepted hybrid THA were followed up. Components migration, periprosthetic bone changes, the polyethylene wear rate were measured radiologically. Kaplan-Meier analysis was performed to evaluate the survival of the acetabular and femoral components. End point was obvious radiological loosening or revision either or both of the acetabular and femoral components for aseptic loosening, infection or osteolysis debridement surgery.

RESULTSA total of 79 cases (85 hips) had been given follow-up. Using revision as the end point, the survival rate of acetabular was 95.2%, cemented femoral components was 98.8%. Using loosening as the end point for failure, the survival rate of acetabular was 97.6%, cemented femoral components was 100%.

CONCLUSIONSThe hybrid total hip prosthesis long-term survival rate was satisfactory, especially in the femoral side. As a result of third-cement technology, the long-term survival rate of the femoral components was close to the modern cementless prosthesis.

Adult ; Aged ; Aged, 80 and over ; Arthroplasty, Replacement, Hip ; methods ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo investigate the clinical results of modified Sutherland pelvic osteotomy for developmental dysplasia of hip (DDH).

METHODSSutherland pelvic osteotomy were performed in 10 patients (11 hips) with DDH. Among them, there were 3 male (3 hips) and 7 female (8 hips) patients, aged (32 ± 8) years. During operation, arthroscopes were performed additionally to remove the existing hyperplasia tissue in the fossae ovalis and trimming acetabulum and glenoid labrum, thus to insure the better match between the femoral head and the realigned acetabulum. The change of imaging indexes were acquired by comparing the preoperative X-ray with the postoperative X-ray. The change of hip function and life quality were acknowledged according to contrast and analysis Harris hip score and Short Form 12-items Health Survey (SF-12) before and after osteotomy.

RESULTSAll patients were followed up for a mean of (5.2 ± 2.3) years, the osteotomy were all union in 3 months. The acetabular head index was 71 ± 8 before operation, and 86 ± 4 after operation. The pre- and post-operative centre edge angle were (7 ± 9)° and (33 ± 9)°, sharp angle were (48 ± 4)° and (37 ± 5)°, acetabular index angle were (24 ± 8)° and (11 ± 5)° respectively. The average Harris score improved from 42 ± 13 preoperatively to 90 ± 5 postoperatively, with 100% excellent and good results. Every domains of SF-12 was improved in the different extents postoperatively, the improvement of physical component summary was more conspicuous than mental component summary. The imaging indexes, Harris and SF-12 were all improved with significant difference (all P < 0.05).

CONCLUSIONSThe modified Sutherland pelvic osteotomy is effective. It could increase the load bearing capacity of hip, and improve the quality of life.

Adult ; Arthroscopy ; Female ; Hip Dislocation, Congenital ; surgery ; Humans ; Male ; Osteotomy ; methods ; Pelvic Bones ; surgery ; Treatment Outcome

OBJECTIVETo observe the clinicopathological characteristics of gastric cancer with pathological complete response(pCR) following neoadjuvant chemotherapy.

METHODSData of gastric cancer patients who received neoadjuvant chemotherapy from 2002 to 2008 in the Beijing Cancer Hospital were reviewed. Five cases were found to have pCR. The slides were reviewed by two experienced pathologists independently. Histological structure, morphology of tumor cells, morphology and quantity of stromal cells were evaluated.

RESULTSStructure of the gastric wall was distinguishable in all the 5 cases, while distortion and rupture of muscular layer were found in 2 cases. Exudative inflammatory reaction was present in the whole gastric wall including the serosa layer. Three patients had ulcerative lesions with epithelial layer shedding, and atypical hyperplasia was found around the border of the ulcer, and vascular endothelial cells were swollen. Residual distorted necrotic tumor cells resided in 1 case only and no residual tumor cells was present in the other 4 patients. Significant hyperplasia of fibroblasts was present in 4 cases, large amount of lymphocytes infiltration in 3 cases including concurrent plasma cell infiltration in 1 case, multinucleated giant cell reaction in the muscular layer of 1 case, and foam cells aggregation in 1 case with mucinous adenocarcinoma. In addition, there were 2 cases with pCR had lymph node metastasis.

CONCLUSIONSFor cases with pCR following neoadjuvant chemotherapy, heterogeneity of stromal cells reaction is found in previous tumor site. Furthermore, the response of primary tumor does not necessarily parallel to that of lymph nodes.

Adult ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoadjuvant Therapy ; Stomach Neoplasms ; drug therapy ; pathology

OBJECTIVETo analyze the results of cortical windowing of the femoral diaphysis for well-fixed cement/plug removal during hip revision surgery.

METHODSFrom May 2005 to June 2009, 14 patients (14 hips) were undergone revision total hip arthroplasty (THA), window was cut into the cortex of the femur, and the well-fixed cement/plug distal to the window was removed under the direct vision. After reimplanted the cementless revision stem, the cortical lids were replanted and fixed with 2 to 3 cerclage wires. Six patients who had suffered from osteoporosis were undergone morselized bone graft to the osteotomy site. Postoperatively, the patients were maintained at partial weight-bearing (touchdown) for 6 weeks and then advanced as they were able.

RESULTSThe length of the cortical windows varied from 2.5 to 6.0 cm (mean, 3.4 cm), the width ranged from 0.8 to 1.4 cm (mean, 1.2 cm). In one patient the window was enlarged during the procedure to facilitate the cement/plug removal. The mean radiologically healing time for the windows was 19 weeks. There was no intraoperative femoral perforation during cement/plug removal. One femoral fracture during the revision stem was implanted. No postoperative periprosthetic fracture and other complications such as infection, implant subsidence occurred during the fellow-up. There was no femoral thigh pain or implant loosening with femoral window.

CONCLUSIONThe cortical windowing technique is very helpful to facilitate the well-fixed cement/plug distal to the prosthesis tip removal and the windows heal rapidly and decrease the femoral complications associated with revision THA.

Aged ; Arthroplasty, Replacement, Hip ; Bone Cements ; Device Removal ; methods ; Female ; Femur ; surgery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Reoperation ; Retrospective Studies

OBJECTIVETo retrospectively analyze the clinical and radiological results of the impaction morselized allografting combined with cementless long stem for femoral component revision in patients with significant bone loss.

METHODSFrom July 2003 to June 2009, 27 patients (27 hips) underwent revision hip arthroplasty in femurs with bone defect using impaction allografting and cementless components. There were 15 male and 12 female with mean age of 67 years. According to the Paprosky classification system, the bone defects in femur were classified into type II in 3 cases, type III in 21 cases and type IV 3 cases. The patients were followed up postoperatively to observe the clinical and radiological results, and if there had the stem subsidence, periprosthetic fracture, infection and other complications.

RESULTSTwenty-three patients were followed up. The mean follow-up time was 26 months. Harris score improved from 43 points pre-revision to 83 points at the final follow-up. No femoral stem loosening and failure occurred. There were 4 stem with a mean 3.3 mm subsidence. One case had an acute infection after revision and treated successfully by debridement and drainage, antibiotics. No stem need further revision. Radiographic analysis showed all the revised stem was stable, and graft incorporation was seen in at least 1 zone in 100% of the femurs.

CONCLUSIONThe results of this study demonstrates that femoral support and vigorous impaction grafting combined with cementless long stem results in an good intermediated-term clinical effects.

Aged ; Arthroplasty, Replacement, Hip ; Bone Transplantation ; methods ; Female ; Femur ; surgery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prosthesis Design ; Reoperation ; Retrospective Studies ; Transplantation, Homologous ; Treatment Outcome