Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
Abstract. Introduction Re-infection rates remain high after revision for periprosthtic joint infection (PJI). We conducted a complex diagnostic study of hip PJI and studied bone tissue involvement into the infectious process. Material and methods Twenty-nine patients treated for PJI were examined....
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| Autores principales: | , , , , , |
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| Formato: | article |
| Lenguaje: | EN RU |
| Publicado: |
Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
2021
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| Materias: | |
| Acceso en línea: | https://doaj.org/article/0cc132ba71794ec19eea5525a1b78be1 |
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| Sumario: | Abstract. Introduction Re-infection rates remain high after revision for periprosthtic joint infection (PJI). We conducted a complex diagnostic study
of hip PJI and studied bone tissue involvement into the infectious process. Material and methods Twenty-nine patients treated for PJI were examined.
Ten patients had acute, seven had late and 12 hematogenous infection (Tsukayama, 1996). Clinical, laboratory, microbiological, radiographic and
histological methods were used for PJI detection. Results ESR exceeded the threshold in 16 and CRP in 23 cases. Pathogenic microorganisms were
confirmed in 23 cases. Radiographic manifestations of periprosthetic bone destruction were seen in 14 patients with late and hematogenous infection.
The histological study showed signs of osteomyelitis in 19 patients, including five cases with acute PJI. Histological study of periprosthetic and
pseudosynovial membranes revealed PJI in 20 patients. The histological and microbiological tests together confirmed PJI in 27 cases (92 %). ROC
analysis showed that the accuracy of CRP in the diagnosis of osteomyelitis exceeded that of ESR due to its higher sensitivity. Microbiological tests
showed satisfactory sensitivity but low specificity. The radiographic study had an extremely low sensitivity and low specificity. Histology of membranes
was quite sensitive and specific for the diagnosis of osteomyelitis but did not reach the level of bone histology. Conclusions Our complex diagnostic
study has enabled to accurately characterize the septic process in revision arthroplasty. The histological findings show that osteomyelitis of different
severity might develop in each PJI type. This fact may be a key factor for a surgeon in choosing a more reliable treatment option. |
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