Clinical research of debridement with prosthesis retention for periprosthetic joint infection after arthroplasty_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

SONG Xinggui ^# , LI Xin , SONG Junlei , XU Chi , LI Rui , LI Heng ,  CHEN Jiying

Department of Orthopaedics, General Hospital of Chinese PLA, Beijing, 100853, P.R.China;

Corresponding author：

CHEN Jiying, Email: chenjiying_301@126.com

Keywords：

Total hip arthroplasty; total knee arthroplasty; periprosthetic joint infection; debridement; complication; influence factor

DOI：

10.7507/1002-1892.201711105

Video：

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ObjectiveTo investigate the mid-term effectiveness of debridement with prosthesis retention for periprosthetic joint infection (PJI) after total hip arthroplasty (THA) and total knee arthroplasty (TKA), and analyze the influence factors that affected the effectiveness.MethodsA clinical data of 45 cases with PJI after THA (16 cases) and TKA (29 cases) that were treated with debridement with prosthesis retention between January 2011 and January 2015 were collected and analyzed. There were 19 males and 26 females with a mean age of 58.4 years (range, 23-78 years). PJI occurred after primary joint arthroplasty in 40 cases and after revision in 5 cases. The mean time interval between the performance of infection symptoms and the arthroplasty or revision was 15.5 months (range, 0.5-72.0 months). The time interval between the performance of infection symptoms and debridment was 35 days (range, 3-270 days). There were early postoperative infections in 13 cases, acute hematogenous infections in 24 cases, and late chronic infections in 8 cases. X-ray films showed that the location of prosthesis was good. The results of bacilli culture showed that 28 cases were positive and 17 were negative. Twelve cases had sinuses. Length of stay, Hospital for Special Surgery (HSS) score, and Harris score were recorded to evaluate risk factors by using a multivariate logistic regression.ResultsThe mean length of stay was 22.6 days (range, 5-79 days). All patients were followed up 24-74 months (mean, 52 months). There were 33 cases that retained the prosthesis without further evidence of infection with the success rate was 73.3%. There were significant differences in Harris score and HSS score between pre- and post-operation (P<0.05). The univariate analysis results showed that the failure of debridement with prosthesis retention had a significant correlation with sinus developing and duration of infection symptoms more than 14 days (P<0.05). Multivariate logistic regression analysis results showed that sinus developing was an independent risk factor of failure (P<0.05).ConclusionDebridement with prosthesis retention plays an important role in treating PJI after THA and TKA. These patients with sinus performing and duration of infection symptoms more than 14 days have higher risk to develop infection again.

Citation： SONG Xinggui, LI Xin, SONG Junlei, XU Chi, LI Rui, LI Heng, CHEN Jiying. Clinical research of debridement with prosthesis retention for periprosthetic joint infection after arthroplasty. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(6): 685-693. doi: 10.7507/1002-1892.201711105 Copy

1.	Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1): e1-e25.
2.	Kurtz SM, Lau E, Watson H, et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty, 2012, 27(8 Suppl): 61-65.e1.
3.	Bongartz T, Halligan CS, Osmon DR, et al. Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum, 2008, 59(12): 1713-1720.
4.	Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
5.	Phillips JE, Crane TP, Noy M, et al. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg (Br), 2006, 88(7): 943-948.
6.	Puhto AP, Puhto T, Syrjala H. Short-course antibiotics for prosthetic joint infections treated with prosthesis retention. Clin Microbiol Infect, 2012, 18(11): 1143-1148.
7.	Jämsen E, Varonen M, Huhtala H, et al. Incidence of prosthetic joint infections after primary knee arthroplasty. J Arthroplasty, 2010, 25(1): 87-92.
8.	Nguyen M, Sukeik M, Zahar A, et al. One-stage exchange arthroplasty for periprosthetic hip and knee joint infections. Open Orthop J, 2016, 10(Suppl-2): 646-653.
9.	Kini SG, Gabr A, Das R, et al. Two-stage revision for periprosthetic hip and knee joint infections. Open Orthop J, 2016, 10: 579-588.
10.	Moran E, Byren I, Atkins BL. The diagnosis and management of prosthetic joint infections. J Antimicrob Chemother, 2010, 65 Suppl 3: iii45-54.
11.	Schmalzried TP. The infected hip: telltale signs and treatment options. J Arthroplasty, 2006, 21(4 Suppl 1): 97-100.
12.	Fisman DN, Reilly DT, Karchmer AW, et al. Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis, 2001, 32(3): 419-430.
13.	Workgroup Convened by the Musculoskeletal Infection S. New definition for periprosthetic joint infection. J Arthroplasty, 2011, 26(8): 1136-1138.
14.	Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg (Am), 1996, 78(4): 512-523.
15.	Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A Suppl 1: S75-80.
16.	Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
17.	Beaver RJ, Mahomed M, Backstein D, et al. Fresh osteochondral allografts for post-traumatic defects in the knee. A survivorship analysis. J Bone Joint Surg (Br), 1992, 74(1): 105-110.
18.	Harris WH, McGann WA. Loosening of the femoral component after use of the medullary-plug cementing technique. Follow-up note with a minimum five-year follow-up. J Bone Joint Surg (Am), 1986, 68(7): 1064-1066.
19.	Hodgkinson JP, Shelley P, Wroblewski BM. The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties. Clin Orthop Relat Res, 1988, (228): 105-109.
20.	Buller LT, Sabry FY, Easton RW, et al. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplasty, 2012, 27(6): 857-864.e1-4.
21.	Geurts JA, Janssen DM, Kessels AG, et al. Good results in postoperative and hematogenous deep infections of 89 stable total hip and knee replacements with retention of prosthesis and local antibiotics. Acta Orthop, 2013, 84(6): 509-516.
22.	Triantafyllopoulos GK, Poultsides LA, Zhang W, et al. Periprosthetic knee infections treated with irrigation and debridement: outcomes and preoperative predictive factors. J Arthroplasty, 2015, 30(4): 649-657.
23.	Tattevin P, Crémieux AC, Pottier P, et al. Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis, 1999, 29(2): 292-295.
24.	Triantafyllopoulos GK, Poultsides LA, Sakellariou VI, et al. Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome. Int Orthop, 2015, 39(6): 1203-1209.
25.	Brandt CM, Sistrunk WW, Duffy MC, et al. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis, 1997, 24(5): 914-919.
26.	Mah TF, Pitts B, Pellock B, et al. A genetic basis for Pseudomonas aeruginosa biofilm antibiotic resistance. Nature, 2003, 426(6964): 306-310.
27.	Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
28.	邵正海, 张玉发, 徐卫东. 有效足量抗生素配合清创手术治疗假体相关感染保留置入假体的疗效分析. 中国骨与关节损伤杂志, 2016, 31(4): 349-352.
29.	Devoto G, Gallo F, Marchello C, et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem, 2006, 52(12): 2281-2285.
30.	Jaberi FM, Parvizi J, Haytmanek CT, et al. Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty. Clin Orthop Relat Res, 2008, 466(6): 1368-1371.
31.	Mainous MR, Deitch EA. Nutrition and infection. Surg Clin North Am, 1994, 74(3): 659-676.
32.	Azzam KA, Seeley M, Ghanem E, et al. Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplasty, 2010, 25(7): 1022-1027.
33.	Kuiper JW, Vos SJ, Saouti R, et al. Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthop, 2013, 84(4): 380-386.
34.	Vilchez F, Martinez-Pastor JC, Garcia-Ramiro S, et al. Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridement. Clin Microbiol Infect, 2011, 17(3): 439-444.
35.	Martinez-Pastor JC, Muñoz-Mahamud E, Vilchez F, et al. Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open debridement and retention of the prosthesis. Antimicrob Agents Chemother, 2009, 53(11): 4772-4777.
36.	Cierny G 3rd, DiPasquale D. Periprosthetic total joint infections: staging, treatment, and outcomes. Clin Orthop Relat Res, 2002, (403): 23-28.
37.	Phelan DM, Osmon DR, Keating MR, et al. Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature. Clin Infect Dis, 2002, 34(7): 930-938.
38.	Azzam K, Parvizi J, Jungkind D, et al. Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg (Am), 2009, 91 Suppl 6: 142-149.
39.	Nobile CJ, Johnson AD. Candida albicans biofilms and human disease. Annu Rev Microbiol, 2015, 69: 71-92.
40.	Kim YH, Kim JS, Park JW, et al. Cementless revision for infected total hip replacements. J Bone Joint Surg (Br), 2011, 93(1): 19-26.
41.	Choong PF, Dowsey MM, Carr D, et al. Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampinbased regimen. Acta Orthop, 2007, 78(6): 755-765.
42.	Byren I, Bejon P, Atkins BL, et al. One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother, 2009, 63(6): 1264-1271.
43.	Westberg M, Grøgaard B, Snorrason F. Early prosthetic joint infections treated with debridement and implant retention: 38 primary hip arthroplasties prospectively recorded and followed for median 4 years. Acta Orthop, 2012, 83(3): 227-232.
44.	Zürcher-Pfund L, Uçkay I, Legout L, et al. Pathogen-driven decision for implant retention in the management of infected total knee prostheses. Int Orthop, 2013, 37(8): 1471-1475.
45.	Aboltins CA, Page MA, Buising KL, et al. Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. Clin Microbiol Infect, 2007, 13(6): 586-591.
46.	Choi HR, von Knoch F, Kandil AO, et al. Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop, 2012, 36(4): 723-729.
47.	Mont MA, Waldman B, Banerjee C, et al. Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplasty, 1997, 12(4): 426-433.
48.	Van Kleunen JP, Knox D, Garino JP, et al. Irrigation and debridement and prosthesis retention for treating acute periprosthetic infections. Clin Orthop Relat Res, 2010, 468(8): 2024-2028.
49.	Triantafyllopoulos G, Poultsides LA, Zhang W, et al. Multiple irrigation and debridements for periprosthetic joint infections: facing a necessity or just prolonging the inevitable? J Arthroplasty, 2016, 31(1): 219-224.
50.	Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J, 2013, 95-B(11): 1450-1452.
51.	叶一林, 柴卫兵, 李军, 等. 保留假体的关节清创术结合术后持续灌洗治疗人工关节置换术后急性假体周围感染. 中国矫形外科杂志, 2011, 19(13): 1057-1060.
52.	Royo A, Bertrand ML, Ramos L, et al. Is there still a place for continuous closed irrigation in the management of periprosthetic total knee infection? Open Orthop J, 2013, 7: 205-210.
53.	陈哲峰, 范卫民, 李翔, 等. 国内人工关节术后假体周围感染的细菌学分析. 南京医科大学学报 (自然科学版), 2009, 29(5): 721-725.
54.	Sendi P, Rohrbach M, Graber P, et al. Staphylococcus aureus small colony variants in prosthetic joint infection. Clin Infect Dis, 2006, 43(8): 961-967.
55.	Choi HR, Kwon YM, Freiberg AA, et al. Periprosthetic joint infection with negative culture results: clinical characteristics and treatment outcome. J Arthroplasty, 2013, 28(6): 899-903.
56.	Parvizi J, Erkocak OF, Della Valle CJ. Culture-negative periprosthetic joint infection. J Bone Joint Surg (Am), 2014, 96(5): 430-436.

1. Osmon DR, Berbari EF, Berendt AR, et al. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis, 2013, 56(1): e1-e25.
2. Kurtz SM, Lau E, Watson H, et al. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty, 2012, 27(8 Suppl): 61-65.e1.
3. Bongartz T, Halligan CS, Osmon DR, et al. Incidence and risk factors of prosthetic joint infection after total hip or knee replacement in patients with rheumatoid arthritis. Arthritis Rheum, 2008, 59(12): 1713-1720.
4. Pulido L, Ghanem E, Joshi A, et al. Periprosthetic joint infection: the incidence, timing, and predisposing factors. Clin Orthop Relat Res, 2008, 466(7): 1710-1715.
5. Phillips JE, Crane TP, Noy M, et al. The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg (Br), 2006, 88(7): 943-948.
6. Puhto AP, Puhto T, Syrjala H. Short-course antibiotics for prosthetic joint infections treated with prosthesis retention. Clin Microbiol Infect, 2012, 18(11): 1143-1148.
7. Jämsen E, Varonen M, Huhtala H, et al. Incidence of prosthetic joint infections after primary knee arthroplasty. J Arthroplasty, 2010, 25(1): 87-92.
8. Nguyen M, Sukeik M, Zahar A, et al. One-stage exchange arthroplasty for periprosthetic hip and knee joint infections. Open Orthop J, 2016, 10(Suppl-2): 646-653.
9. Kini SG, Gabr A, Das R, et al. Two-stage revision for periprosthetic hip and knee joint infections. Open Orthop J, 2016, 10: 579-588.
10. Moran E, Byren I, Atkins BL. The diagnosis and management of prosthetic joint infections. J Antimicrob Chemother, 2010, 65 Suppl 3: iii45-54.
11. Schmalzried TP. The infected hip: telltale signs and treatment options. J Arthroplasty, 2006, 21(4 Suppl 1): 97-100.
12. Fisman DN, Reilly DT, Karchmer AW, et al. Clinical effectiveness and cost-effectiveness of 2 management strategies for infected total hip arthroplasty in the elderly. Clin Infect Dis, 2001, 32(3): 419-430.
13. Workgroup Convened by the Musculoskeletal Infection S. New definition for periprosthetic joint infection. J Arthroplasty, 2011, 26(8): 1136-1138.
14. Tsukayama DT, Estrada R, Gustilo RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg (Am), 1996, 78(4): 512-523.
15. Tsukayama DT, Goldberg VM, Kyle R. Diagnosis and management of infection after total knee arthroplasty. J Bone Joint Surg (Am), 2003, 85-A Suppl 1: S75-80.
16. Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty. An end-result study using a new method of result evaluation. J Bone Joint Surg (Am), 1969, 51(4): 737-755.
17. Beaver RJ, Mahomed M, Backstein D, et al. Fresh osteochondral allografts for post-traumatic defects in the knee. A survivorship analysis. J Bone Joint Surg (Br), 1992, 74(1): 105-110.
18. Harris WH, McGann WA. Loosening of the femoral component after use of the medullary-plug cementing technique. Follow-up note with a minimum five-year follow-up. J Bone Joint Surg (Am), 1986, 68(7): 1064-1066.
19. Hodgkinson JP, Shelley P, Wroblewski BM. The correlation between the roentgenographic appearance and operative findings at the bone-cement junction of the socket in Charnley low friction arthroplasties. Clin Orthop Relat Res, 1988, (228): 105-109.
20. Buller LT, Sabry FY, Easton RW, et al. The preoperative prediction of success following irrigation and debridement with polyethylene exchange for hip and knee prosthetic joint infections. J Arthroplasty, 2012, 27(6): 857-864.e1-4.
21. Geurts JA, Janssen DM, Kessels AG, et al. Good results in postoperative and hematogenous deep infections of 89 stable total hip and knee replacements with retention of prosthesis and local antibiotics. Acta Orthop, 2013, 84(6): 509-516.
22. Triantafyllopoulos GK, Poultsides LA, Zhang W, et al. Periprosthetic knee infections treated with irrigation and debridement: outcomes and preoperative predictive factors. J Arthroplasty, 2015, 30(4): 649-657.
23. Tattevin P, Crémieux AC, Pottier P, et al. Prosthetic joint infection: when can prosthesis salvage be considered? Clin Infect Dis, 1999, 29(2): 292-295.
24. Triantafyllopoulos GK, Poultsides LA, Sakellariou VI, et al. Irrigation and debridement for periprosthetic infections of the hip and factors determining outcome. Int Orthop, 2015, 39(6): 1203-1209.
25. Brandt CM, Sistrunk WW, Duffy MC, et al. Staphylococcus aureus prosthetic joint infection treated with debridement and prosthesis retention. Clin Infect Dis, 1997, 24(5): 914-919.
26. Mah TF, Pitts B, Pellock B, et al. A genetic basis for Pseudomonas aeruginosa biofilm antibiotic resistance. Nature, 2003, 426(6964): 306-310.
27. Marculescu CE, Berbari EF, Hanssen AD, et al. Outcome of prosthetic joint infections treated with debridement and retention of components. Clin Infect Dis, 2006, 42(4): 471-478.
28. 邵正海, 张玉发, 徐卫东. 有效足量抗生素配合清创手术治疗假体相关感染保留置入假体的疗效分析. 中国骨与关节损伤杂志, 2016, 31(4): 349-352.
29. Devoto G, Gallo F, Marchello C, et al. Prealbumin serum concentrations as a useful tool in the assessment of malnutrition in hospitalized patients. Clin Chem, 2006, 52(12): 2281-2285.
30. Jaberi FM, Parvizi J, Haytmanek CT, et al. Procrastination of wound drainage and malnutrition affect the outcome of joint arthroplasty. Clin Orthop Relat Res, 2008, 466(6): 1368-1371.
31. Mainous MR, Deitch EA. Nutrition and infection. Surg Clin North Am, 1994, 74(3): 659-676.
32. Azzam KA, Seeley M, Ghanem E, et al. Irrigation and debridement in the management of prosthetic joint infection: traditional indications revisited. J Arthroplasty, 2010, 25(7): 1022-1027.
33. Kuiper JW, Vos SJ, Saouti R, et al. Prosthetic joint-associated infections treated with DAIR (debridement, antibiotics, irrigation, and retention): analysis of risk factors and local antibiotic carriers in 91 patients. Acta Orthop, 2013, 84(4): 380-386.
34. Vilchez F, Martinez-Pastor JC, Garcia-Ramiro S, et al. Outcome and predictors of treatment failure in early post-surgical prosthetic joint infections due to Staphylococcus aureus treated with debridement. Clin Microbiol Infect, 2011, 17(3): 439-444.
35. Martinez-Pastor JC, Muñoz-Mahamud E, Vilchez F, et al. Outcome of acute prosthetic joint infections due to gram-negative bacilli treated with open debridement and retention of the prosthesis. Antimicrob Agents Chemother, 2009, 53(11): 4772-4777.
36. Cierny G 3rd, DiPasquale D. Periprosthetic total joint infections: staging, treatment, and outcomes. Clin Orthop Relat Res, 2002, (403): 23-28.
37. Phelan DM, Osmon DR, Keating MR, et al. Delayed reimplantation arthroplasty for candidal prosthetic joint infection: a report of 4 cases and review of the literature. Clin Infect Dis, 2002, 34(7): 930-938.
38. Azzam K, Parvizi J, Jungkind D, et al. Microbiological, clinical, and surgical features of fungal prosthetic joint infections: a multi-institutional experience. J Bone Joint Surg (Am), 2009, 91 Suppl 6: 142-149.
39. Nobile CJ, Johnson AD. Candida albicans biofilms and human disease. Annu Rev Microbiol, 2015, 69: 71-92.
40. Kim YH, Kim JS, Park JW, et al. Cementless revision for infected total hip replacements. J Bone Joint Surg (Br), 2011, 93(1): 19-26.
41. Choong PF, Dowsey MM, Carr D, et al. Risk factors associated with acute hip prosthetic joint infections and outcome of treatment with a rifampinbased regimen. Acta Orthop, 2007, 78(6): 755-765.
42. Byren I, Bejon P, Atkins BL, et al. One hundred and twelve infected arthroplasties treated with ‘DAIR’ (debridement, antibiotics and implant retention): antibiotic duration and outcome. J Antimicrob Chemother, 2009, 63(6): 1264-1271.
43. Westberg M, Grøgaard B, Snorrason F. Early prosthetic joint infections treated with debridement and implant retention: 38 primary hip arthroplasties prospectively recorded and followed for median 4 years. Acta Orthop, 2012, 83(3): 227-232.
44. Zürcher-Pfund L, Uçkay I, Legout L, et al. Pathogen-driven decision for implant retention in the management of infected total knee prostheses. Int Orthop, 2013, 37(8): 1471-1475.
45. Aboltins CA, Page MA, Buising KL, et al. Treatment of staphylococcal prosthetic joint infections with debridement, prosthesis retention and oral rifampicin and fusidic acid. Clin Microbiol Infect, 2007, 13(6): 586-591.
46. Choi HR, von Knoch F, Kandil AO, et al. Retention treatment after periprosthetic total hip arthroplasty infection. Int Orthop, 2012, 36(4): 723-729.
47. Mont MA, Waldman B, Banerjee C, et al. Multiple irrigation, debridement, and retention of components in infected total knee arthroplasty. J Arthroplasty, 1997, 12(4): 426-433.
48. Van Kleunen JP, Knox D, Garino JP, et al. Irrigation and debridement and prosthesis retention for treating acute periprosthetic infections. Clin Orthop Relat Res, 2010, 468(8): 2024-2028.
49. Triantafyllopoulos G, Poultsides LA, Zhang W, et al. Multiple irrigation and debridements for periprosthetic joint infections: facing a necessity or just prolonging the inevitable? J Arthroplasty, 2016, 31(1): 219-224.
50. Parvizi J, Gehrke T, Chen AF. Proceedings of the international consensus on periprosthetic joint infection. Bone Joint J, 2013, 95-B(11): 1450-1452.
51. 叶一林, 柴卫兵, 李军, 等. 保留假体的关节清创术结合术后持续灌洗治疗人工关节置换术后急性假体周围感染. 中国矫形外科杂志, 2011, 19(13): 1057-1060.
52. Royo A, Bertrand ML, Ramos L, et al. Is there still a place for continuous closed irrigation in the management of periprosthetic total knee infection? Open Orthop J, 2013, 7: 205-210.
53. 陈哲峰, 范卫民, 李翔, 等. 国内人工关节术后假体周围感染的细菌学分析. 南京医科大学学报 (自然科学版), 2009, 29(5): 721-725.
54. Sendi P, Rohrbach M, Graber P, et al. Staphylococcus aureus small colony variants in prosthetic joint infection. Clin Infect Dis, 2006, 43(8): 961-967.
55. Choi HR, Kwon YM, Freiberg AA, et al. Periprosthetic joint infection with negative culture results: clinical characteristics and treatment outcome. J Arthroplasty, 2013, 28(6): 899-903.
56. Parvizi J, Erkocak OF, Della Valle CJ. Culture-negative periprosthetic joint infection. J Bone Joint Surg (Am), 2014, 96(5): 430-436.

Chinese Journal of Reparative and Reconstructive Surgery

Clinical research of debridement with prosthesis retention for periprosthetic joint infection after arthroplasty

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