1. 2008/12/23

2. Chart No Name Age/Se x DiagnosisOperation Mortality & Morbidity 0000000 陳 00 1.S/P left bipolar prosthesis with acetabular wear 2.Asthma 3.Gastroesophageal Reflux Disease 4.Duodenal ulceration 5.GB stone 6.Anxiety state 7.HBV 97/11/18 revision THR infection 00000000 潘 00 1.Right femoral subtrochanteric fracture s/p ORIF on 12/8 2.Right radio-ulna fracture s/p ORIF on 12/12 3.Grade II liver laceration 4.Right thigh contussion injury 97/12/8 DHS for right femur 97/12/12 plate for right forearm post-OP wound infection and massive discharge 00000000 陳 00 1.left femoral neck fracture 2.T12 compression fracture 3.hypertension 4.scabies 97/12/10 Moore infection

3. Chart No Name Age/Sex DiagnosisOperation Mortality & Morbidity 0000000 張 00 1.right intertrochanteric fracture post DHS and cannulated screw 10/28 2.UTI 3.hypertension 97/12/15 THR and cable wire fixation revision 00000000 許 00 1.Right hip prosthesis cup loosening 2 years ago at LMD 2.Gout history 97/11/28 revision cup Cup failure 00000000 陳 00 1.left femoral supracondylar fracture with nonunion 2.HTN 3.hepatitis C with cirrhosis 97/12/19 condylar plate nonunion 00000000 黃 00 1.right intertrochanteric fracture post dynamic hip screw, with plate failure and nonunion, in this August 2.UTI 97/12/05 DHSrevision

4. OKU 9 Discussion

5.  Arthroplasty: infection 1~2 %  S. aureus, S epidermidis  Classification:  Type Ipositive culture after surgical revision  Type IIpositive culture 30 days after OP  Type IIIhematogenous spread  Type IVchronic or late infection

6. Diagnosis:  Pain: night pain / rest pain  Arthrocentesis:  1.7X10 9 /L or 65% > blood; 94-97% sen, 88-98% spe  ESR, CRP, IL-6, blood culture, WBC/DC  Plain X-ray  99m Tc / leukocyte scanning

7. Diagnosis establish 1. Growth of the same organism discovered via two or more diagnostic methods 2. Acute inflammation on histology 3. Gross purulence 4. Actively discharging sinus tract

8.  Antibiotics only:  Poor medical condition, unable to remove prosthesis  Pathogen low virulence / susceptible to oral Anti  Anti has fewer adverse reactions  Prosthesis is not loose  40/225 (18%) TKR; 62/261 (24%) TKR success treated by antibiotics  4~6 weeks than shaft to oral anti

9.  OPEN debridement  Acute postoperative time frame (type II)  Hematogenous spread (type III)  Criteria:  < 2 weeks duration  G(+) organism  No sinus tract / drainage  No loosening of the prosthesis

10.  Revision (one stage / two stage)  Delayed reimplantation (after 6 weeks IV antibiotics treat / 3~4 weeks anti + anti cement): good result 