Abstract
Background. Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery. The leading cause of hip revisions is aseptic loosening of components, knee joint periprosthetic infection (PPI). Some of the infectious complications, including those related to mechanical causes, remain out of sight. The aim of the study was to identify the frequency of unexpected infections during revision knee and hip arthroplasty performed for aseptic complications of any etiology. Materials and Methods. 839 cases of revision arthroplasty of knee and hip joints were analyzed, including 485 aseptic revisions in 450 patients. Clinical, X-ray, laboratory (complete blood count and comprehensive metabolic panel, coagulation panel) methods, synovial fluid analysis and microbiological examination of punctures, including intraoperative ones, were used. The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection. Results. The average age of patients at the time of the revision was 61.7 years. The hip joint prevailed (59.4%), knee joint 40.6%. The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints. In 8 out of 10 cases, the causative agents were coagulase-negative staphylococci, including 6 MRSE; in two cases, anaerobic bacteria. All revisions were carried out by a one-stage method. Patients with detected PPI underwent systemic antibacterial therapy. At the stage of catamnesis, reinfection was assumed in one of the 10 identified cases of PPI, the patient did not show up for revision. In control 63% of the group of the other (aseptic) 470 patients, PPI developed in 4 cases, two-stage revisions were carried out. Conclusions. The frequency of infections accidentally detected during aseptic revisions of large joints was 2.08%. Three-time examination of joint punctures, including intraoperative, provides additional opportunities for the diagnosis of PPI during aseptic revision, and also allows you to choose the optimal stage of revision treatment. The experience gained makes it possible in certain cases to perform one-stage revision in the treatment of PPI.
Highlights
Data from the national registers of arthroplasty showed that about 12% of hip and knee arthroplasty undergo revision within 10 years after the primary surgery
The ICM and EBJIS (European Bone and Joint Infections Society) consensus recommendations were used as criteria for assessing the presence of infection
The growth of microorganisms in the intraoperative biomaterial was detected in 2.08% of observations: in 10 out of 287 patients after aseptic revision of the hip joints and in none of the 198 revisions of the knee joints
Summary
Нами проведено ретроспективное сплошное одноцентровое исследование всех случаев асептической ревизионной артропластики КС и ТБС, выполненных в ФГБУ «Федеральный центр травматологии, ортопедии и эндопротезирования» Минздрава России Лабораторный скрининг включал исследование общего анализа крови со скоростью оседания эритроцитов (СОЭ), биохимическое исследование крови с определением С-реактивного белка (СРБ), коагулограмму с D-димером; анализ синовиальной жидкости с подсчетом лейкоцитов и процентного содержания полиморфноядерных нейтрофилов. В дальнейшем проводили подсчет количества лейкоцитов, лейкоцитарной формулы и микробиологическое исследование пунктата. При небольшом количестве материала для подсчета клеточных элементов синовиальной жидкости использовали бинокулярный микроскоп и пластиковые камеры слайд-планшета. Интраоперационно выполняли взятие 4–6 тканевых биоптатов по крайней мере из 4 различных точек, а также суставной жидкости (при наличии). Уровень СРБ в плазме крови более 10 мг/л; СОЭ >30 мм/час; D-димер >860 нг/мл, повышение уровня лейкоцитов в синовиальной жидкости >2000 клеток/мкл, повышенное процентное количество полиморфноядерных нейтрофилов >70% расценивали в качестве дополнительных («малых») диагностических признаков ППИ [18, 29].
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