Infection after total hip arthroplasty is a rare but potentially devastating complication. The most common pathogens responsible for these infections are gram positive bacteria. Infection caused by fungi is uncommon. There are few reports of prosthetic joint infection caused by Candida species, and there has no report of implant preservation. We experienced the case of a patient with Candida arthritis who underwent total hip arthroplasty for hip arthrosis, and successfully could preserved prosthetic joint. A 60 year-old woman underwent total hip arthroplasty in September 2014. She had had the past of sepsis by the Candida after surgery of the duodenal cancer. After four weeks in total hip arthroplasty, she made clinic visits. Her chief complaints were low-grade fever of 1 week's duration and discharge from operative scar for THA. The patient underwent arthrocentesis of the left hip. The culture was positive for Candida tropicalis. Operation of surgical debridement and liner change was performed as soon as possible. After operation, the patient was treated with fluconazole intravenously for 28 days. She has continued to taken fluconazole by mouth. Reactivation of infection have not been in her left hip. We reported the case of a patient with Candida arthritis who underwent total hip arthroplasty. Prosthetic joint could have preserved because of early detection for infection. This is the first report of preservating implant after Candida infection in total hip arthroplasty.
The purpose of this study was to introduce our perioperative prophylaxis method for infection and clarify surgical site infection rate in our patients performed total hip arthroplasty (THA). Two hundred and eighty four THA (including revision 18 cases) performed by single surgeon between Oct. 2007 and Jan. 2013 were evaluated. The mean age of patients was 65.7 years old. The male to female ratio was 46 to 238. BMI was 23.6. Ninety patients (32%) were compromised host suffering from diabetes mellitus, rheumatoid arthritis, autoimmune disease, history of malignant tumor, hemodialysis or skin disease at surgical site respectively. At preoperative period, we checked decayed tooth, alveolar pyorrhea, hemorrhoids, and leg skin condition. In addition, we examined culture of nasal cavity. At the day of surgery, patient took a shower just before entering surgical room. All of THA was performed in clean room NASA class 100. Surgeons and assistant nurse put on nonwoven fabric gown, space suit and double rubber gloves. We wiped surgical site leg by gauze impregnated by 0.5% chlorhexidine alchohol to eliminate skin bacteria twice just before surgeons scrubbing hands. Surgical site was covered by povidone iodine containing drape. Surgeons or nurse changed gloves when glove was broken at each time. We cleaned surgical field by pulse washer whenever necessary. We did not use drain except for 5 revision THAs. Regarding to prophylactic antibiotics usage, we administered cefcapene pivoxil orally the day before surgery. Drip infusion antibiotics (PIPC: until Oct. 2008, CEZ: after Oct. 2008) was administered at the period of 30 min. before surgery and 4 hours after surgery in case of prolonged surgical time (4 hours >). Skin closure was performed by staple and covered by gauze until May 2010. After that, we used surgical tape and transparent water proof sheet. After finishing surgery, antibiotic was administered 8 hours interval at surgery day and 12 hours interval for additional two days. In case multi-drug resistant bacteria (MRSA, MRSE) was positive in nasal culture, we applied mupirocin ointment to nasal cavity for 3 days before surgery and administered vancomycin (from Aug. 2011) or linezolid (from 2012) for prophylactic antibiotics in perioperative period.Introduction
Method
In patients who underwent autogenous iliac bone grafting we studied prospectively injury to the lateral femoral cutaneous nerve (LFCN) in relation to the size (length, depth, width) of the graft. We also examined the neurological deficit, by questioning them about numbness and/or pain in the lateral thigh. The risk of injury was significantly higher in those in whom the depth of the graft was more than 30 mm. With regard to the length of the graft the incidence of nerve injury was 20% when the graft was 45 mm long or more, 16% when it was between 30 mm and 45 mm long, and 8% when it was less than 30 mm long. We should inform patients of the possibility of such injury, and take size into consideration when harvesting grafts from the ilium.
