A 18-case report：antibacterial irrigation through the sinus tract for periprosthetic infection after hip arthroplasty

CHEN Tao; YU Run-ze; ZHANG Jie-bin; SHANG Xi-fu

doi:10.3969/j.issn.2095-252X.2013.08.006

Abstract： Objective To investigate the clinical results of antibacterial irrigation through the sinus tract for periprosthetic infection after hip arthroplasty. Methods From September 2005 to September 2011, 18 patients with periprosthetic infection after total hip arthroplasty ( THA ) were adopted in Anhui Provincial Hospital and Anhui Provincial No.2 People’s Hospital. Early infection occurred in 7 cases, interim infection in 8 cases and advanced infection in 3 cases. No significant fever was observed in all patients. The drainage fluid was cultured and drug susceptibility test was performed, with bacteria cultured. The sterile tube was inserted into the articular cavity through the sinus tract, which was repeatedly irrigated by normal saline and hydrogen peroxide respectively. The sensitive antibiotics were selected according to the drug susceptibility test, and then were inserted into the articular cavity through the sterile tube, which was kept for drainage. The times of antibacterial irrigation were determined by the drainage volume. After dressing changing, the patients were instructed to be on crutches out of bed. In the late stage, the drainage volume became less. Bacteria were cultured for 3 times to show negative results. The sterile tube was pulled out after antibacterial irrigation, and then the sinus tract got healed. The blood routine, biochemistry, C-reactive protein ( CRP ) and erythrocyte sedimentation rate ( ESR ) were reviewed regularly in the treatment. Good nutritional status was maintained. Results After 3 weeks of treatment, the sinus tract got healed. The Harris hip score increased from an average of 35.8 points preoperatively to 70.6 points postoperatively. The blood routine was back to normal. The CRP was 30 mg/L on average, and the ESR was 35.6 mm/h on average. Except for 1 patient who chose to take out the prosthesis because of medical disputes, the other 17 patients were satisfied with the clinical results. Conclusions With nutrition strengthened, in some patients in stable conditions with prosthesis infection after total hip replacement, the sterile tube is inserted into the articular cavity through the sinus tract to irrigate repeatedly. The sensitive antibiotics are selected according to the drug susceptibility test, and then are inserted into the articular cavity through the sterile tube. The sinus tract can get healed, and the function of hip joints can get recovered.