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.
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.
Sokurova Alla Mikhailovna — PhD in Biological sciences (Cand. Bio. Sci.), Associate Professor, Associate Professor of the Department of microbiology, virology and immunology of the St. Petersburg State Pediatric Medical University, 2 Litovskaya Street, 194100 St. Petersburg, Russian Federation; e-mail: amsokurova@gmail.com.
Fadeev Evgeniy Mikhailovich – PhD in Medical Sciences (Cand. Med. Sci.), Associate 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.
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.
Stepanov Aleksandr Sergeevich – postgraduate student of Department of medical microbiology, NorthWest State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation; e-mail: aleksandr.stepanov@szgmu.ru.
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, North-West 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.
Usikov Vadim Vladimirovich – PhD in Medical Sciences (Cand. Med. Sci.), Associate 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.
Lishchuk Aleksandr Aleksandrovich – resident in the field of Traumatology and Orthopedics, North-West State Medical University named after I.I. Mechnikov, 47 Piskarevskiy Ave, 195067 St. Petersburg, Russian Federation.
In the heading: Original researches
Year: 2024 Volume: 6 Journal number: 3
Pages: 20-34
Article type: scientific and practical
UDC: 616-093:616.728.2-089-616.728.3-089
DOI: 10.26211/2658-4522-2024-6-3-20-34
Introduction. Instability of the endoprosthesis after hip arthroplasty is not a rare complication and serves as an indication for revision arthroplasty. In cases where the growth of microflora is not detected during preoperative punctures, instability is diagnosed as aseptic. Such patients are operated on in a clean department, and they undergo simultaneous re-endoprosthetics. At the same time, in recent years, reports have increasingly begun to appear that an in-depth microbiological examination of removed implants reveals an increase in slightly virulent microflora, which does not allow us to consider the instability of the endoprosthesis aseptic.
Aim. The purpose of the study: to improve the diagnosis of periprosthetic infection in the presence of low-virulent infection and aseptic instability of the hip and knee joints.
Materials and methods. The analysis of the applied methods of diagnosis of periprosthetic infectionin 173 patients undergoing treatment in the clinic of traumatology and orthopedics with instability of the components of the endoprosthesis was carried out. All patients underwent a comprehensive clinical, hematological and microbiological examination before performing revision arthroplasty. The removed unstable components of the endoprosthesis, the altered tissues to be changed, material from the femoral canal and acetabulum, synovial fluid, periprosthetic membrane (if any), smears from the wound, pieces of bone tissue were selected as material for microbiological examination. The analysis of the results was carried out using the software of the device used for conducting PCR in “real time” mode, the STATISTICA 10 software system was used for statistical processing of the results obtained. Quantitative parameters using nonparametric x2 methods, Fisher criteria, Mann-Whitney criteria.
Results. Microbiological examination of tissue biopsies taken during surgery is crucial for the diagnosis of periprosthetic infection. Positive results were found in 41 (23.7 %), which is 2 times more significant (p<0.05) than from the punctures taken before surgery. In the first group, 24 (20.3 %) had positive results, and in the second 17 (30.9 %), which is significantly (p<0.05) 2 times higher than from the punctures taken before the re-endoprosthesis operation. In all patients with positive microbiological examination results obtained during the puncture, they turned out to be similar to the biopsies obtained during the reendoprosthesis operation. At the same time, it should be noted that the microbial landscape in 31 (65.8 %) of 41 patients with positive punctates coincided with the microbiota obtained during joint puncture in patients with unstable endoprostheses. In the remaining 14 (34.1 %) patients, gram-positive microflora associations were additionally seeded in the form of gram-negative associations in the main low-virulent microflora.
Discussion. The bacteriological (cultural) method allows you to see firsthand the presence of the pathogen, assess its amount, and determine sensitivity to antimicrobial drugs in several developed and standardized ways. The phenotypic resistance detected in the bacteriological method makes it possible to select resistant strains for further testing for the presence of resistance genes in PCR.
Conclusion. Microbiological diagnosis is crucial when choosing tactics for the treatment and prevention of periprosthetic infection. However, the effectiveness of microbiological research is not high enough: seeding of punctures before surgery and biopsies obtained during revision surgery allows you to get a positive result only in 10-15 % of cases. But relapses or infectious complications after re-endoprosthesis are found in patients even with negative results of microbiological examination.
Keywords: coagulase-negative staphylococci, endoprosthetics, hip replacement, joint instability, periprosthetic joint infection, S. epidermidis
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