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:	Artem M. Ermakov, Tamara A. Silant'eva, Zinaida S. Naumenko, Nikolai M. Kliushin, Tatiana A. Malkova, Alexander V. Burtsev
Formato:	article
Lenguaje:	EN RU
Publicado:	Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics 2021
Materias:	arthroplasty hip joint periprosthetic infection periprosthetic/pseudosynovial membrane osteomyelitis clinical laboratory tests histology Orthopedic surgery RD701-811
Acceso en línea:	https://doaj.org/article/0cc132ba71794ec19eea5525a1b78be1
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spelling	oai:doaj.org-article:0cc132ba71794ec19eea5525a1b78be12021-11-15T09:50:13ZComplex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis10.18019/1028-4427-2021-27-5-540-5471028-44272542-131Xhttps://doaj.org/article/0cc132ba71794ec19eea5525a1b78be12021-10-01T00:00:00Zhttps://doaj.org/toc/1028-4427https://doaj.org/toc/2542-131XAbstract. 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.Artem M. ErmakovTamara A. Silant'evaZinaida S. NaumenkoNikolai M. KliushinTatiana A. MalkovaAlexander V. BurtsevRussian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedicsarticlearthroplastyhip jointperiprosthetic infectionperiprosthetic/pseudosynovial membraneosteomyelitisclinical laboratory testshistologyOrthopedic surgeryRD701-811ENRUГений oртопедии, Vol 27, Iss 5, Pp 540-547 (2021)
institution	DOAJ
collection	DOAJ
language	EN RU
topic	arthroplasty hip joint periprosthetic infection periprosthetic/pseudosynovial membrane osteomyelitis clinical laboratory tests histology Orthopedic surgery RD701-811
spellingShingle	arthroplasty hip joint periprosthetic infection periprosthetic/pseudosynovial membrane osteomyelitis clinical laboratory tests histology Orthopedic surgery RD701-811 Artem M. Ermakov Tamara A. Silant'eva Zinaida S. Naumenko Nikolai M. Kliushin Tatiana A. Malkova Alexander V. Burtsev Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
description	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.
format	article
author	Artem M. Ermakov Tamara A. Silant'eva Zinaida S. Naumenko Nikolai M. Kliushin Tatiana A. Malkova Alexander V. Burtsev
author_facet	Artem M. Ermakov Tamara A. Silant'eva Zinaida S. Naumenko Nikolai M. Kliushin Tatiana A. Malkova Alexander V. Burtsev
author_sort	Artem M. Ermakov
title	Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
title_short	Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
title_full	Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
title_fullStr	Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
title_full_unstemmed	Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
title_sort	complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis
publisher	Russian Ilizarov Scientific Center for Restorative Traumatology and Orthopaedics
publishDate	2021
url	https://doaj.org/article/0cc132ba71794ec19eea5525a1b78be1
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Complex diagnostic study of twenty-nine patients revised for periprosthetic hip joint reinfection and the role of the histological method in detection of osteomyelitis

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