Postoperative management included: Conventional antibiotics were applied intraoperatively to prevent infection, and antibacterial drugs were applied prophylactically within 24 hours postoperatively. Tranexamic acid 1 was given intravenously 3 hours postoperatively. Subcutaneous anticoagulation with 4100 U of low-molecular heparin was started 10 hours after surgery, qd × 5 days. After discharge, the patient was given oral rivaroxaban 10 mg, qd × 14 days. Ice packs were applied intermittently for 48 hours after surgery, and the dressing was changed every other day. The incision was removed at 12 to 14 days postoperatively with outpatient review. The patient started normal weight-bearing walking with the aid of a walker 1 day after surgery THA. Patients were instructed to actively flex and extend the knee joint, perform ankle pump exercises and quadriceps isometric contraction exercises as well as passive exercises 1 day after surgery.
Validated updated version of diagnostic criteria for PJI in 2018 are as follows[13 (link)] (based on the diagnostic criteria of PJI proposed by the Musculoskeletal infection society in 2011):
Two positive cultures or the presence of a sinus tract were considered major criteria and diagnostic of PJI. The calculated weights of an elevated serum CRP (>1 mg/dL), D-dimer(>860ng/mL) and ESR (>30mm/hour) were 2, 2 and 1 points, respectively. Elevated synovial fluid WBC count (>3000 cells/µL), alpha-defensin (signal-to cutoff ratio > 1), LE (++), PMN% (>80%) and synovial CRP (>6.9mg/L) received 3, 3, 3, 2 and 1 points, respectively. Patients with an aggregate score of greater than or equal to 6 were considered infected while a score between 2 and 5, required the inclusion of intraoperative findings for confirming or refuting the diagnosis. Intraoperative findings of positive histology, purulence and single positive culture were assigned 3, 3, and 2 points, respectively. Combined with the preoperative score, a total of greater than or equal to 6 was considered infected, a score between 4 and 5 was inconclusive, and a score of 3 or less was not infected.
Validated updated version of diagnostic criteria for PJI in 2018 are as follows[13 (link)] (based on the diagnostic criteria of PJI proposed by the Musculoskeletal infection society in 2011):
Two positive cultures or the presence of a sinus tract were considered major criteria and diagnostic of PJI. The calculated weights of an elevated serum CRP (>1 mg/dL), D-dimer(>860ng/mL) and ESR (>30mm/hour) were 2, 2 and 1 points, respectively. Elevated synovial fluid WBC count (>3000 cells/µL), alpha-defensin (signal-to cutoff ratio > 1), LE (++), PMN% (>80%) and synovial CRP (>6.9mg/L) received 3, 3, 3, 2 and 1 points, respectively. Patients with an aggregate score of greater than or equal to 6 were considered infected while a score between 2 and 5, required the inclusion of intraoperative findings for confirming or refuting the diagnosis. Intraoperative findings of positive histology, purulence and single positive culture were assigned 3, 3, and 2 points, respectively. Combined with the preoperative score, a total of greater than or equal to 6 was considered infected, a score between 4 and 5 was inconclusive, and a score of 3 or less was not infected.
