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BACKGROUND: Periprosthetic joint infection, a serious complication after artificial joint arthroplasty, has always been a thorny problem in clinical practice. At present, the research on the characteristics of the pathogenic bacteria is insufficient, and more research is needed to help clinical diagnosis and treatment. OBJECTIVE: To explore the distribution and drug resistance of pathogens in periprosthetic joint infection after knee and hip arthroplasties, and to compare the characteristics of different pathogen culture results. METHODS: A retrospective single-center research was used to study the data of 102 cases of periprosthetic joint infection in the Department of Orthopedics, First Affiliated Hospital of Zhengzhou University from September 2013 to September 2020. Pathogen culture results, drug resistance, and other diagnosis and treatment information were collected. According to the results of pathogen culture, the patients were divided into four groups: gram-positive bacteria, gramnegative bacteria, fungi, and negative culture. The differences in general condition, clinical features, operation methods, and infection control were compared among the four groups. RESULTS AND CONCLUSION: (1) Totally 66 of 102 patients with periprosthetic joint infection were cultured positive for pathogenic bacteria, and 71 strains of pathogenic bacteria were detected. Gram-positive bacteria accounted for 57.8%. Staphylococcus epidermidis (21.1%) and Staphylococcus aureus (15.5%) were the most common. Gram-negative bacteria accounted for 29.6% and Escherichia coli (12.7%) was the most common. Fungi accounted for 12.7%, with Candida parapsilosis (5.6%) being the most common. (2) Gram-positive bacteria had high resistance rates to penicillin G, oxacillin, clindamycin, and erythromycin, and 0% to vancomycin, tigecycline, and linezolid. Gram-negative bacteria had a high resistance rate to antibiotics such as quinolones, gentamicin, ampicillin, and cefazolin; no drug-resistant fungi had been found. (3) There was no significant difference in sex, age, basic disease, operation site, infection type, sinus, operation mode, and infection control rate among the four groups (P > 0.05). In early infection, the C reactive protein in culture negative group was lower than that in gram-positive bacteria group (P < 0.05), and red serum sedimentation rate and white blood cell count in culture negative group were significantly lower than those in gram-negative bacteria group (P < 0.05). Leukocyte, C-reactive protein, and erythrocyte sedimentation rate of hip periprosthetic infection were higher than those of knee periprosthetic infection (P < 0.05). (4) It is concluded that the main pathogen causing periprosthetic joint infection is still gram-positive bacteria, of which Staphylococcus accounts for the largest proportion. The increase of Candida parapsilosis infection is worthy of attention. Multiple pathogenic bacteria have a high drug resistance rate to some conventional antibiotics, so the use of antibiotics should be adjusted in time according to the results of drug susceptibility and efficacy. [ABSTRACT FROM AUTHOR]

BACKGROUND: Anterior cruciate ligament knee reconstruction under arthroscopy is the most effective treatment for anterior cruciate ligament injury. However, the choice of graft in anterior cruciate ligament reconstruction is still controversial, which is the key problem to be solved facing clinicians. OBJECTIVE: To explore the clinical efficacy of autologous, mixed, and simple ligament advanced reinforcement system ligaments in anterior cruciate ligament reconstruction. METHODS: Totally 132 patients who were admitted to First Affiliated Hospital of Zhengzhou University from January 2016 to January 2019 and underwent anterior cruciate ligament reconstruction were enrolled in this study. These patients were divided into autologous group, mixed group, and artificial group (n=44) according to the different graft selections. Among them, the autologous group took the medial half tendon and femoral tendon of the calf tibial nodules and woven into autologous ligament for treatment. Patients in the mixed group were treated with semi-tendon, femoral tendon and ligament advanced reinforcement system artificial ligament graft. Patients with the artificial group were treated with ligament advanced reinforcement system artificial ligament. Before and 2 years after operation, Lysholm score, International Knee Documentation Committee (IKDC) score, Lachman test, Tegner score, and HSS score were used to evaluate the recovery of the knee. At the same time, the bone tunnel enlargement value, ligament growth factors, quality of life, and recovery time were observed. RESULTS AND CONCLUSION: (1) The time for patients in the mixed group to resume daily activities and exercise after surgery was earlier than that of the autologous group and the artificial group (P < 0.05). The SF-36 score of the quality of life 2 years after surgery was higher in the mixed group than that of the autologous group and the artificial group (P < 0.05). The complication rates of the mixed group and the artificial group were lower than that of the autologous group (P < 0.05). (2) The knee joint function of the three groups of patients recovered to varying degrees. The Lysholm score, IKDC score, and Tegner score of the mixed group were higher than those of the autologous group and the artificial group at 0.5, 1, and 2 years after operation (P < 0.05). The KT1000 knee range of motion of the mixed group was less than that of the autologous group and the artificial group (P < 0.05) at 1 and 2 years after operation. The bone tunnel enlargement value at 1 year after operation was lower in the mixed group than that of autologous group and artificial group (P < 0.05). The HSS scores at 0.5, 1, and 2 years after operation were higher in the mixed group than those of the autologous group and the artificial group (P < 0.05). The number of normal people in Lachman test at 2 years after operation was more in the mixed group than that of autologous group and artificial group (P < 0.05). (3) The levels of ligament growth factor transforming growth factor β1 and basic fibroblast growth factor in the mixed group were higher than those in the autologous group and the artificial group at 0.5, 1, and 2 years after surgery (P < 0.05). (4) It is concluded that the mixed ligament can be used as the primary graft for clinic, and is more helpful in helping patients return to normal work and life as soon as possible. However, the use of mixed ligaments still has practical problems, such as the need to extract autologous tendons and high medical costs. [ABSTRACT FROM AUTHOR]

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