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1.
Chinese Journal of Orthopaedics ; (12): 752-759, 2018.
Article in Chinese | WPRIM | ID: wpr-708594

ABSTRACT

Objective To determine whether a periprosthetic joint infections (PJI) patient derived S.aureus is an appropriate candidate tool bacterium for studying the pathogenesis of S.aureus-induced PJI.Methods Whole genome sequencing data of ST1792 was obtained using the Illumina Hiseq platform of a Staphylocuccal.aureus(S.aureus) strain derived from a PJI prosthesis,and gene functional enrichment analysis based on gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) database was performed.Besides,its biofilm formation ability in drainage fluid,synovial fluid and human plasmin were compared to that in experimental cultures,in order to determine differences in biofilm forming ability in different environment.In addition,based on Illumina Hiseq platform,transcriptome analysis of the S.aureus in the three types of fluid above was performed to determine its gene expression profile and functional enrichment analysis of the differentially expressed genes was conducted through the GO and KEGG database.Finally,adaptability in different human fluid of the S.aureus was analyzed with the transcriptome profile and biofilm formation data.Results The genome of ST1792 consisted of 2 718 coding sequences,including main virulence encoding genes and regulation related genes.Functional enrichment showed no sign of significant missing or major recombination in the bacterial genome.The biofilm mass in plasmin was much higher than that in synovial fluid,both significantly higher than the biofilm mass in TSB.But the biofilm mass in drainage fluid was not statistically different from that in TSB.This revealed that the bacterial biofilm phenotype was significantly altered in PJI human fluid.Transcriptomics sequencing revealed that a huge number of genes were differentially expressed in drainage fluid,synovial fluid and human plasmin compared to TSB.Functional enrichment revealed that the bacterial gene expression profile was different in PJI human fluids,which showed the sophisticated adaptation of the bacterium to human fluid environment.Conclusion As a clinical S.aureus isolated from a PJI patient,ST1792 presents distinct phenotypes and adaptations in vivo,so it is a proper candidate for future studies in the pathogenesis of S.aureus induced PJI.

2.
Chinese Journal of Orthopaedics ; (12): 549-555, 2018.
Article in Chinese | WPRIM | ID: wpr-708570

ABSTRACT

Objective To explore the clinical effects of optimized articulating medullary-sparing spacer in the treatment of infectious hip arthritis.Methods From June 2010 to June 2016,the clinical data of 15 patients with infectious hip arthritis who were treated by modified articulating medullary-sparing spacer were analyzed retrospectively.There were 6 males and 9 females with the average age of 49.6±9.6 years old (range,32-61 years).8 cases were primary hip infections and 7 cases were secondary hip joint infections.After complete debridement in the first phase of surgery,the modified articulating medullary-sparing spacers were fabricated and installed using the larger diameter and angled Steinmann pins as the endoskeleton and the femoral head spacers made by hubbing.Two-stage THA revision for each patient was conducted after infection controlled.To evaluate the clinical results,the infection and treatment condition of every patient were collected at preoperative,interim period and latest fellow-up.The spacer status in interim period and prosthesis status after two-stage THA revision were observed.And Harris hip score system was used to evaluate the hip joint function in different stages.Results All patients were cured with mean follow-up time of 40.9± 10.8 months (range,28-62 months).During the interim period,spacer dislocation was observed in a case,which was successfully treated by manual reduction under general anesthesia.In other cases,the affected limbs maintained good function and partial weight bearing.After the second-stage THA,no prosthesis loose,dislocation,fracture,deep vein thrombosis and injury of major vessels or nerves were observed.The clinical symptoms and hip joint function of all cases were significantly improved.The Harris hip score was improved from 33.7±6.9 preoperatively to 59.5±8.5 in interim period and 90.8±4.4 at the latest fellow-up,and the difference was statistically significant among three stages.Conclusion The larger diameter and angled Steinmann pins as the endoskeleton,combined with the femoral head spacers made by hubbing,effectively enhanced the mechanical strength of the articulating medullary-sparing spacers.The optimized spacers provided effective treatment of infectious hip arthritis,while allowing good function and partial weight-bearing during the interim period.

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