Abstract
Objective Assess the immune status of children with ischemic deformity of the proximal femur taking into account the treatment outcome. Material and methods Preoperative assessment of the immune status was performed for 16 adolescents with ischemic deformity of the proximal femur. Patients' age was 14.4 ± 0.45 years. Immunological parameters of 12 adolescents with satisfactory (group I) and 4 patients with poor (group II) anatomical and functional outcome of surgical treatment were compared. Peripheral blood lymphocyte typing was produced with laser cytometry assay, and IgA, IgM, IgG, IgE, IL-18, IFNγ and circulating immune complexes were quantified with enzyme-linked immunoassay. Results Сomparative analysis of preoperative immunological parameters showed statistically significant decline of Т-helper cells (СD3+СD4+), high levels of activated СD3+CD25 and СD3+HLADR T lymphocytes, low levels of activated NК cells (СD8dimCD38+) and IFNγ in group II. Humoral immune parameters indicated to low levels of IgA, IgM, IgG and higher levels of circulating immune complexes in group II relative to group I. Conclusion Preliminary data obtained suggest that cellular and humoral immune deficiency can be associated with unfavorable outcome of joint preservation procedure. Such immunological parameters as T lymphocytes subpopulation, immunoglobulins, circulating immune complexes and IFNγ can be used as significant prognostic factors for preoperative planning and postoperative rehabilitation of adolescents with ischemic deformity of the proximal femur.
Highlights
Hip dysplasia encompasses a spectrum of abnormal hip development with pathological malalignment of the proximal femur, asphericity, spatial malorientation of the hip, large femoral head and a short femoral neck
Patients of group II showed lower proportion of T helper cells (СD3+СD4+), higher percentage of СD3+СD8+ T lymphocytes, higher proportion of T lymphocytes with T cell activation proportion of activated T lymphocytes (СD3+CD25 markers CD25 and HLADR, lower proportion and СD3+HLADR, СD8brightCD38+), lower proportion of activated NK cells (СD8dimCD38+), lower of activated NK cells (СD8dimCD38+) and lower level levels of immunoglobulins of primary classes and of IFNγ in group II
Our findings suggest that good anatomical and functional outcome of surgical treatment can be provided for patients with normal baseline cellular immunity and moderate activation of the humoral immunity
Summary
Hip dysplasia encompasses a spectrum of abnormal hip development with pathological malalignment of the proximal femur, asphericity, spatial malorientation of the hip, large femoral head and a short femoral neck. These alterations can be associated with clinical presentation of primary or secondary acetabular dysplasia. The combined deformities can result in unstable hip joint, incongruent articular surfaces and lead to progressive arthritis in younger individuals. On the one hand reconstruction of hip joint biomechanics would delay the onset of coxarthrosis [1, 2, 3]. On the other hand reconstructive procedure performed with incongruent articular surfaces is likely to increase risk of progression of irreversible changes in the joint. Levels of cytokins and immunoglobulins, lymphocyte population and subpopulation have been demonstrated to be affected with progression of arthritis [5, 6, 7, 8, 9]
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