Evaluation of the infections of knee and hip joint prosthesis: A clinical experiment

Aim: In this experiment we aimed to determine the factors which pose a risk through the time elapsed between the first prosthesis surgery and the diagnosed infection, and also how these factor influence the process. Another objective is to find out the relation between these reasons, themselves, and how the patients who has chronical comorbidities has been affected of them; so as to contribute to improve right strategies for the diagnosis, recovery and prevention of prosthesis infections. Method: We examined the patients, who had admitted us because of prothesis infections and had operated in another center (75) or our center (61) between June 2003 and March 2012, according to 21 parameters. We evaluated the age, gender, the reason of the prothesis, the duration of hospitalisations,the area of operation, comorbidities (DM, RA, HT), the medications used for prophylaxis, usage of steroids, whether the operation had been done urgent or elective, which process have been performed, the duration of the operation and the discharge from the wound. Also the pain, sedimentation, CRP values and the wound cultures had been evaluated. All these data have been collected from the retrospective scanning of the patent histories for the infectious diseases' clinic, epicrisis from outer centers, monitoring reports of the Radiology Department, the probel data system which used in our hospital, laboratory and microbiological findings, nursery follow-up files. SPSS (vers. 15.0, IBM corporation, 2001) is used for the statistical analysis. Findings: The population (136) that have been diagnosed as prosthesis infection was consisted of %72,1 women and %27,9 men. Of the cases, %63,9 were older than 65, and %31,6 were between 45 and 64. The infected hip prosthesis formed the %45,6 and the knee prosthesis %54,4. The reason of the prothesis surgery obtained as arthrosis (gonarthrosis, coxarthrosis) with the percentage of 47,7. %91,2 of the patients had 2 or more operations before. Result: In this research that we evaluated the prosthesis infections, the pain had been the most prevalent symptom (%89,7). After the %23 of the surgeries, which had performed before the infection, a discharge detected. The most used antibiotic for the prophylaxis after the surgeries was cephalosporins (81,6). When the prosthesis infection has been diagnosed, the values of sedimentation were higher than 10 with the ratio of %71,2 and of the sedimentation were higher than 30 with the ratio of 83,1. HT was % 41,9, DM was %25 and RA was %9,6 among the comorbidities. In the first sessions of the most of the surgical treatments (%52,9) of the prothesis infections, prothesis was taken out and debridated. 47,8 % of cultures taken during surgery due to prosthetic infection were negative. Methicillin-resistant coagulase negative Staphylococcus was the most common (%25,7 %) bacterial growth in positive cultures. Patients who were 65 years and over, using corticosteroid, and having hypertension, had statistically significant more wound discharge after prothesis surgery. (p<0.05). Its known that wound discharge is a risk factor for infection. Older age and corticosteroid usage is also risk factors for infection, but we did not find any knowledge about hypertension as a risk factor for infection after prothesis surgery in literatures. In our experiment we found out hypertension is a risk factor for prothesis infections of joints. Treatment algorythm of patiens having hypertension going under prothesis surgery of joints should be reorganized. Key words: knee prothesis, hip prothesis, prothesis complications, infection and hypertension, culture positivity, discharge after prothesis, sedimentation, crp, debridement, two stage prothesis surgery.