Optimization of diagnosis of periprosthetic infection in instability of hip and knee endoprosthesis

Authors:

Linnik Stanislav Antonovich—Grand PhD in Medical sciences (Dr. Med. Sci.), Professor of the Department of Traumatology, Orthopedics and Military Surgery, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: stanislavlinnik@mail.ru; https://orcid.org/0000-0002-4840-6662.

Orishak Elena Aleksandrovna — PhD in Medical sciences (Cand. Med. Sci.), Associate Professor of the Department of Medical Microbiology, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: Elena.Orishak@szgmu.ru; https://orcid.org/0000-0002-4562-4402.

Nilova Lyudmila Yurievna — PhD in Medical sciences (Cand. Med. Sci.), Associate Professor of the Department of Medical Microbiology, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: lyudmila.nilova@szgmu.ru; https://orcid.org/0009-0005-8898-9152.

Korshunov Dmitry Yurievich — Head of the Department of Traumatology and Orthopedics N 1, Federal Center for Traumatology, Orthopedics and Endoprosthetics, 29 Stroiteley Ave, 214019 Smolensk, Russian Federation; e-mail: dmi02041976@yandex.ru; https://orcid.org/0009-0005-9819-0598.

Tsololo Iaroslav Borisovich — assistant at the Department of Traumatology, Orthopedics and Military Surgery, NorthWest State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: yaroslav.tsololo@gmail.com; https://orcid.org/0000-0001-7744-0002.

Kucheev Ivan Olegovich — PhD in Medical sciences (Cand. Med. Sci.), Head of the 2nd Traumatology and Orthopedic Department, Hospital for War Veterans, 21/2 Narodnaya Street, 193079 St. Petersburg, Russian Federation; e-mail: 9513533@mail.ru; https://orcid.org/0000-0001-8557-843X.

Ismael Abbas — orthopedic traumatologist, City Clinic N 23, 17 Kosinova Street, 198079 St. Petersburg, Russian Federation; e-mail: ismael-abbas@mail.ru; https://orcid.org/0000-0003-4652-6588.

Sizykh Alena Alekseevna — resident of the Department of Traumatology, Orthopedics and Military Surgery, NorthWest State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: salova95@icloud.com; https://orcid.org/0009-0003-6040-7910.

Maltseva Elena Vasilievna — student of the Faculty of Medicine, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: lena_kuznetsova_2000@list.ru; https://orcid.org/0009-0003-8732-3901.

Bulygina Polina Yurievna — student of the Faculty of Medicine, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: pollinaa.bulygina@yandex.ru; https://orcid.org/0009-0000-0204-235X.

Annotation:

Introduction. Endoprosthetics of large joints of the lower extremities is a highly effective method of treating diseases and consequences of joint injuries and allows to improve the quality of life of patients and restore an active lifestyle.
Instability of the endoprosthesis after hip arthroplasty is not a rare complication and serves as an indication for revision arthroplasty. At the same time, in recent years, reports have increasingly begun to appear that an in-depth microbiological examination of biopsies taken during surgery, soft tissues and bones, and removed implants reveals an increase in slightly virulent microflora, which does not allow us to consider the instability of the endoprosthesis aseptic.

Aim. To evaluate the effectiveness of the diagnosis of periprosthetic infection through a comparative assessment of clinical and laboratory parameters in aseptic instability of endoprosthesis components.

Materials and methods. In the clinic of traumatology and orthopedics of the North-Western State Medical University named after I.I. Mechnikov of the Ministry of Health of Russia from 2021 to 2023 inclusively, 154 patients aged from 29 to 77 years (58.7±6.4) were diagnosed with “Aseptic instability of the hip and knee joints” after primary arthroplasty.
All patients underwent a comprehensive clinical, hematological and microbiological examination before undergoing revision arthroplasty.

Results. When bacteriological examination of punctates and biopsies taken during surgery, samples of periprosthetic tissues, synovial fluid, and swabs from endoprosthetic components, in some cases opportunistic representatives of the human normobiota, predominantly gram-positive facultative anaerobic cocci, are isolated. Microbiological diagnosis is crucial when choosing tactics for treating and preventing periprosthetic infection. The detection of low-virulent microorganisms, and especially coagulase-negative staphylococci (CNS), their small number or absence complicates the interpretation of the results obtained and requires special criteria for assessing the risks of developing periprosthetic infection.

Discussion. In most cases, according to our data and in studies of other authors, gram-positive staphylococci were detected, with a predominance of coagulase-negative staphylococci. The commonality of findings of the same type, primarily coagulase-negative staphylococci, among different authors indicates their significance. Coagulasenegative staphylococci, due to its low virulence with the simultaneous ability to colonize, cause purulent-septic complications with reduced resistance of the patient>s body. Understanding the problems of the role of the coagulasenegative staphylococci is necessary for the use of tactics during audits, preventive measures during primary and repeated surgical interventions, taking into account the prevention of intraoperative infection by the microbiota of patients. Based on the literature data and the results of this study, it is necessary to continue to develop clinical and laboratory tests, including emergency histological examination of periprosthetic tissues, aimed at improving the diagnosis of periprosthetic infection.

Summary. The predominant causative agent of periprosthetic infection is staphylococci, mainly coagulasenegative. Coagulase-negative staphylococci as representatives of the normobiota are characterized by low virulence, but a proven pronounced ability to colonize abiotic objects. Among coagulase-negative staphylococci isolated during periprosthetic infection, the frequency of resistant strains is high, which must be taken into account when prescribing empirical therapy and choosing treatment tactics. The data obtained indicate the need to find new ways to diagnose periprosthetic infection.

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