ObjectiveTo explore the clinical value of metagenomic next-generation sequencing (mNGS) in diagnosis and treatment of periprosthetic joint infection (PJI) after total knee arthroplasty (TKA). MethodsBetween April 2020 and March 2023, 10 patients with PJI after TKA were admitted. There were 3 males and 7 females with an average age of 69.9 years (range, 44-83 years). Infection occurred after 8-35 months of TKA (mean, 19.5 months). The duration of infection ranged from 16 to 128 days (mean, 37 days). The preoperative erythrocyte sedimentation rate (ESR) was 15-85 mm/1 h (mean, 50.2 mm/1 h). The C reactive protein (CRP) was 4.4-410.0 mg/L (mean, 192.8 mg/L). The white blood cell counting was (3.4-23.8)×109/L (mean, 12.3×109/L). The absolute value of neutrophils was (1.1-22.5)×109/L (mean, 9.2×109/L). After admission, the joint fluid was extracted for bacterial culture method and mNGS test, and sensitive antibiotics were chosen according to the results of the test, and the infection was controlled in combination with surgery. Results Seven cases (70%) were detected as positive by bacterial culture method, and 7 types of pathogenic bacteria were detected; the most common pathogenic bacterium was Streptococcus lactis arrestans. Ten cases (100%) were detected as positive by mNGS test, and 11 types of pathogenic bacteria were detected; the most common pathogenic bacterium was Propionibacterium acnes. The difference in the positive rate between the two methods was significant (P=0.211). Three of the 7 patients who were positive for both the bacterial culture method and the mNGS test had the same results for the type of pathogenic bacteria, with a compliance rate of 42.86% (3/7). The testing time (from sample delivery to results) was (4.95±2.14) days for bacterial culture method and (1.60±0.52) days for mNGS test, and the difference was significant (t=4.810, P<0.001). The corresponding sensitive antibiotic treatment was chosen according to the results of bacterial culture method and mNGS test. At 3 days after the one-stage operation, the CRP was 6.8-48.2 mg/L (mean, 23.6 mg/L); the ESR was 17-53 mm/1 h (mean, 35.5 mm/1 h); the white blood cell counting was (4.5-8.1)×109/L (mean, 6.1×109/L); the absolute value of neutrophils was (2.3-5.7)×109/L (mean, 4.1×109/L). All patients were followed up 12-39 months (mean, 23.5 months). One case had recurrence of infection at 6 months after operation, and the remaining 9 cases showed no signs of infection, with an infection control rate of 90%. Conclusion Compared with bacterial culture method, mNGS test can more rapidly and accurately detect pathogenic bacteria for PJI after TKA, which is important for guiding antibiotics combined with surgical treatment of PJI.
Objective To compare the analgesic efficacy and safety of liposomal bupivacaine (LB) versus ropivacaine for surgical incision local anesthesia after artificial intelligence (AI)-assisted direct anterior approach (DAA) total hip arthroplasty (THA). MethodsA prospective randomized controlled study was conducted. A total of 120 patients who underwent AI-assisted DAA-THA between March 2024 and January 2025 were enrolled and randomly assigned to the LB group (n=60) or the “cocktail” group (n=60). Patients in the LB group received an intraoperative injection of LB 266 mg (diluted to 100 mL) around the incision, whereas those in the “cocktail” group received a mixture of ropivacaine 200 mg, compound betamethasone 1 mL, and epinephrine 0.5 mg (diluted to 100 mL). Resting and active visual analogue scale (VAS) scores were recorded at 6, 12, 24, 36, 48, 60, and 72 hours and at 2 and 4 weeks postoperatively. Changes in Pain Catastrophizing Scale (PCS) score, Harris hip score, and hip flexion and abduction range of motion at 4 weeks postoperatively relative to preoperative values were assessed. In addition, operation time, incision length, total postoperative oral morphine consumption, time to first ambulation, length of hospital stay, and complications within 72 hours after surgery were recorded and compared between the two groups. ResultsThere was no significant difference between the two groups in incision length, time to first ambulation, length of hospital stay, or total postoperative oral morphine consumption (P>0.05). Operation time was significantly longer in the LB group than in the “cocktail” group (P<0.05). All patients were followed up for 6 months postoperatively. Both resting and active VAS scores decreased over time in the two groups (P<0.05). Intergroup comparison showed that resting and active VAS scores at 60 and 72 hours postoperatively were significantly lower in the LB group than in the “cocktail” group (P<0.05), whereas no significant difference was observed at other time points (P>0.05). There was no significant difference between the two groups in the changes in PCS score, Harris Hip Score, or hip range of motion at 4 weeks postoperatively (P>0.05). In the LB group, nausea and vomiting occurred in 3 cases, significant blood glucose fluctuations in 2 cases, superficial incision infection in 1 case, and local hematoma in 1 case; the corresponding numbers in the “cocktail” group were 5, 4, 0, and 1 case, respectively. No significant difference was observed between the two groups in the incidence of these complications (P>0.05). No local allergic reactions, deep vein thrombosis, significant blood pressure fluctuations, deep incision infection, skin necrosis, or pulmonary embolism occurred in either group. At last follow-up, satisfaction rates for analgesic efficacy and hip function both exceeded 90% in the two groups, with no significant difference between groups (P>0.05). Conclusion In AI-assisted DAA-THA, local infiltration anesthesia with LB provides analgesic efficacy comparable to that of the “cocktail” therapy during the early postoperative period (within 48 hours). Although VAS scores were slightly lower in the LB group at 60-72 hours postoperatively, the difference was small and the clinical benefit was limited. No significant difference was observed between the two groups in opioid consumption, complication rates, PCS scores, or postoperative functional recovery. In the context of AI-assisted DAA-THA, the clinical advantage of LB over the conventional “cocktail” therapy appears limited.
ObjectiveA prospective randomized controlled study was conducted to investigate the early postoperative analgesic effectiveness of using liposomal bupivacaine (LB) for local infiltration anesthesia (LIA) in unicompartmental knee arthroplasty (UKA). Methods Between January 2024 and July 2024, a total of 80 patients with knee osteoarthritis (KOA) who met the selection criteria were enrolled in the study. Patients were randomly assigned to either the LB group or the “cocktail” group in a 1∶1 ratio using a random number table, with 40 patients in each group. Baseline characteristics, including gender, age, body mass index, operated side, Kellgren-Lawrence grade, and preoperative American Society of Anesthesiologists (ASA) classification, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, and knee joint range of motion, showed no significant difference between the two groups (P>0.05). Both groups received LIA and comprehensive pain management. The surgical duration, incision length, pain-related indicators [resting and activity visual analogue scale (VAS) scores, total dosage of oral morphine, WOMAC scores], knee joint range of motion, first ambulation time after operation, length of hospital stay, and postoperative adverse events. ResultsThere was no significant difference between the two groups in surgical duration, incision length, first ambulation time after operation, length of hospital stay, total dosage of oral morphine, and pre-discharge satisfaction with surgery and WOMAC scores (P>0.05). At 4, 12, and 24 hours after operation, the resting and activity VAS scores in the “cocktail” group were lower than those in the LB group; at 60 and 72 hours postoperatively, the resting VAS scores in the LB group were lower than those in the “cocktail” group, with the activity VAS scores also being lower at 60 hours; all showing significant differences (P<0.05). There was no significant difference in the above indicators between the two groups at other time points (P>0.05). On the second postoperative day, the sleep scores of the LB group were significantly higher than those of the “cocktail” group (P<0.05), while there was no significant difference in sleep scores on the day of surgery and the first postoperative day (P>0.05). Additionally, the incidence of complications showed no significant difference between the two groups (P>0.05). ConclusionThe use of LB for LIA in UKA can provide prolonged postoperative pain relief; however, it does not demonstrate a significant advantage over the “cocktail” method in terms of short-term analgesic effects or reducing opioid consumption and early functional recovery after UKA. Nevertheless, LB may help reduce postoperative sleep disturbances, making it a recommended option for UKA patients with cardiovascular diseases and insomnia or other mental health issues.