Анализ эффективности локального протокола диагностики перипротезной инфекции

Abstract

The diagnosis of periprosthetic joint infection is a difficult task because there is no absolute test to confirm or rule out infection. We have developed a local protocol for diagnosing periprosthetic joint infection to use a combination of diagnostic studies with the highest level of sensitivity and specificity.The purpose of the study: To evaluate the effectiveness of a local protocol for diagnosing periprosthetic joint infection to determine surgical treatment tactics.Methods. We analyzed 283 audits that took place during 2020-2022 at the Federal Center for Traumatology, Orthopedics and Endoprosthetics (Smolensk, Russian Federation). Patients with a preliminary diagnosis of aseptic loosening of knee or hip joint endoprosthesis components and periprosthetic joint infection were monitored. All patients were examined in accordance with the local protocol for the diagnosis of periprosthetic joint infection, which includes clinical and radiological data, CRP and ESR, analysis of the cellular composition of synovial fluid, microbiological examination of biopsies, endoprosthesis components, planned and frozen sections. The final diagnosis was made taking into account clinical and laboratory data. The effectiveness was assessed by delayed treatment results. Results. Positive microbiological cultures were isolated in 165 patients (58%), 150 patients had increased cytosis of synovial fluid (53%), leukocyte esterase was increased in 147 cases, according to the results of an urgent histological examination, 159 conclusions of «infectious type membrane» (56%) were obtained, a combination of increased ESR and CRP was observed in 93 cases.Conclusions. Analysis of the local periprosthetic joint infection diagnostic protocol showed that each stage of diagnosis allows to identify additional cases of infection, therefore, all patients admitted for revision endoprosthetics should be examined throughout hospitalization. The inclusion of urgent histological diagnostics at the intraoperative stage makes it possible to change the tactics of surgical treatment in a timely manner. In general, the local protocol of step-by-step diagnosis of periprosthetic joint infection with the inclusion of urgent histological examination helps to increase the chances of a successful outcome of revision endoprosthesis surgery, regardless of the nature of loosening.