الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Prosthetic joint infection results in disability and mortality. Aged people are more affected. Patient physiological conditions determine the outcome. Diagnosis of PJI is challenging, no single diagnosis can rule out PJI. Current treatments of PJI differ in literature, two-stage revision is considered the gold standard. Patient conditions should be optimized to improve patient general status. In early infections, DAIR can achieve a reduction of infection, with patients required to undergo multiple surgeries.
The burden of PJI is increasing with the increase in the number of joint replacements performed. Emphasis needs to be done to minimize risk factors for PJI, early diagnosis, improvement of patient conditions, and prevention.
The NOF is an urgent procedure; it gives little room for patient optimization and infection risk rule out, contrary to elective total hip arthroplasty. Most patients sustaining NOF are usually older with comorbidities, which increases their risk to acquire PJI.
Hematoma aspiration intraoperative may offer a new possibility in determining the risk organisms cause of PJI.
The investigation focused to determine the success of hematoma aspiration in acute NOF and relation to the occurrence of early PJI.
Forty patients presenting with the acute NOF who presented to El Hadra University Hospital, undergoing hip arthroplasty were investigated. Inclusion criteria included patients with displaced NOF undergoing hip arthroplasty.
Patients with known infection, long duration of antibiotics before hip arthroplasty, aged less than 55 years, neglected fracture presenting more than two weeks post-trauma were excluded from the study.
After approval of the Ethics body, Faculty of Medicine, Alexandria University, enlightened permission was obtained from entire patients who participated in the study.
Personal history (age, sex, occupation, and date of trauma), patient’s complaints (unilateral or bilateral hip pain and swelling), and history (previous surgical procedures, comorbidities) were recorded.
General examination (general and systemic review) and local examination (inspection for deformity, swelling, and deformity) was done.
Physical examination was done to detect the area of maximum tenderness, range of motion. Also, plain X-ray: anteroposterior and lateral view for assessing the bone.
The hematoma was obtained from the patient intraoperative after sterile draping and before capsulotomy. The aspiration procedure was done under a strict aseptic technique using a 10ml syringe. Approximately 4-5ml was aspirated. One sample was collected for each patient. Samples were delivered to the laboratory within 45min to 1 hour. Samples were cultured using conventional cultures and BACT/ALERT. For conventional cultures, all samples were directly streaked onto blood agar, MacConkey’s agar, and chocolate blood agar. Simultaneously, five ml of the sample was inoculated into tryptone soy enrichment broth for subculture after three and seven days. The yield of the colonies was subjected to full identification procedures using gram-stained films and biochemical reactions. About 5ml of the samples were inoculated into BACT/ALERT culture bottles. A few milliliters from positive bottles were withdrawn and placed onto the surface of the plated medium (for culture). Subculture was done onto a chocolate blood agar, blood agar plate, MacConkey’s agar, and streaked for isolation. Signal negative cultures at the maximum test time (5days) were visually examined for turbidity. Identification and susceptibility testing was performed on all significant isolates according to standard procedures.
Patients were followed in a post-operation trauma clinic for eight weeks. The wound was assessed using the Southampton wound scoring system.
Patients with clinical indicators of wound infection were subjected to laboratory tests.
Musculoskeletal joint infection Society (MSIS) criteria were used as diagnostic criteria.
A patient diagnosed with PJI was either subjected to debridement antibiotics and implant retention or a two-stage exchange.
The present study revealed the following results
• Investigated patients’ ages varied from 55-91, 50% less than 65 years, 22.5% less than 75 years, 20% less than 85, and 7.5% more than 85.
• The majority of studied patients (65%) were females.
• The left side was more affected in 62.5% of patients, right side in 27.5%.
• The majority of studied patients (72.5%) were associated with comorbidities. Diabetes in 22.5%, hypertension in 37.5%, stroke in 5%, cardiac disease in 5% and cancer in 2.5%.
• BACT/ALERT was more sensitive 80.00% than conventional culture.
• Patients with a history of previous surgical exposure accounted for 40% of the studied patients.
• Prolonged operation time was statistically significantly associated with early prosthetic joint infection (p= 0.020).
• There was a significant relation between intraoperative hematoma contamination and prophylactic antibiotic (p= 0.000).
• 40% of the studied patient hematoma samples were culture positive for BACT/ALERT.
• The conventional culture was positive in 5% of the studied patients.
• Identified organisms in culture were Staphylococcus spp. In 32.50%, Pseudomonas aeruginosa in 2.5%, Streptococcus in 2.5% and E. coli in 2.5%.
• Early PJI occurred in 10% of intraoperative positive hematoma culture and, 2.5% of intraoperative negative hematoma culture in studied patients.
• PJI was caused by MRSA in 2.5%, E. coli in 2.5%, Pseudomonas in 2.5%, Klebsiella in 2.5%
• Southampton wound scoring system showed a statistically significant relationship with early PJI (p=0.000)
• A significant association was observed between positive BACT/ALERT intraoperative hematoma culture and postoperative infected patients (p=0.02).
• 7.5% of patients with early PJI underwent DAIR, 2.5% received two-stage revisions.
• Death in the studied patient was 5% among the patient with early PJI.