2008/12/23

Chart No Name Age/Se x DiagnosisOperation Mortality & Morbidity 陳 00 1.S/P left bipolar prosthesis with acetabular wear 2.Asthma 3.Gastroesophageal Reflux Disease 4.Duodenal ulceration 5.GB stone 6.Anxiety state 7.HBV 97/11/18 revision THR infection 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 femur 97/12/12 plate for right forearm post-OP wound infection and massive discharge 陳 00 1.left femoral neck fracture 2.T12 compression fracture 3.hypertension 4.scabies 97/12/10 Moore infection

Chart No Name Age/Sex DiagnosisOperation Mortality & Morbidity 張 00 1.right intertrochanteric fracture post DHS and cannulated screw 10/28 2.UTI 3.hypertension 97/12/15 THR and cable wire fixation revision 許 00 1.Right hip prosthesis cup loosening 2 years ago at LMD 2.Gout history 97/11/28 revision cup Cup failure 陳 00 1.left femoral supracondylar fracture with nonunion 2.HTN 3.hepatitis C with cirrhosis 97/12/19 condylar plate nonunion 黃 00 1.right intertrochanteric fracture post dynamic hip screw, with plate failure and nonunion, in this August 2.UTI 97/12/05 DHSrevision

OKU 9 Discussion

 Arthroplasty: infection 1~2 %  S. aureus, S epidermidis  Classification:  Type Ipositive culture after surgical revision  Type IIpositive culture 30 days after OP  Type IIIhematogenous spread  Type IVchronic or late infection

Diagnosis:  Pain: night pain / rest pain  Arthrocentesis:  1.7X10 9 /L or 65% > blood; 94-97% sen, 88-98% spe  ESR, CRP, IL-6, blood culture, WBC/DC  Plain X-ray  99m Tc / leukocyte scanning

Diagnosis establish 1. Growth of the same organism discovered via two or more diagnostic methods 2. Acute inflammation on histology 3. Gross purulence 4. 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 