BACKGROUND: The diagnosis of joint replacement infection is a difficult clinical challenge that often occurs when the implant cannot be salvaged. We hypothesize that the pH value of synovial fluid could be an important indicator of the inflammatory status of the joint. However, in the literature, there is a lack of data on the pH changes in hip and knee joint replacements and their relation to infection and implant failure. In this study, we aimed to measure the pH levels of synovial fluid in patients with hip and knee joint replacements. We also investigated the potential of pH measurement as a diagnostic tool for joint replacement infection. In this study, we recorded the pH values to be 7.55 and 7.46 in patients where Pseudomonas aeruginosa was identified as the cause of the prosthetic joint infection. We attribute this to the different environments created by this specific bacterium. In other cases where the pH was higher, chronic mitigated infections were diagnosed, caused by strains of Staphylococcus aureus, Streptococcus agalactiase, and coagulase negative staphylococcus. MATERIALS AND METHODS: In our cohort of 155 patients with implanted hip (THA; n = 85) or knee (TKA; n = 70) joint replacements, we conducted a prospective study with a pH measurement. Out of the whole cohort, 44 patients had confirmed joint replacement infection (28.4%) (44/155). In 111 patients, infection was ruled out (71.6%) (111/155). Joint replacement infection was classified according to the criteria of the Musculoskeletal Infection Society (MSIS) from 2018. Based on the measured values, we determined the cut-off level for the probability of ongoing inflammation. We also determined the sensitivity and specificity of the measurement. RESULTS: The group of patients with infection (n = 44) had a significantly lower synovial fluid pH (pH = 6.98 ± 0.48) than the group of patients with no infection (n = 111, pH = 7.82 ± 0.29, p < 0.001). The corresponding median pH values were 7.08 for the patients with infection and 7.83 for the patients with no infection. When we determined the cut-off level of pH 7.4, the sensitivity level of infected replacements was 88.6%, and the specificity level of the measurement was 95.5%. The predictive value of a positive test was 88.6%, and the predictive value of a negative test was 95.5%. CONCLUSIONS: Our results confirm that it is appropriate to include a pH measurement in the diagnostic spectrum of hip and knee replacements. This diagnostic approach has the potential to provide continuous in vivo feedback, facilitated by specialized biosensors. The advantage of this method is the future incorporation of a pH-detecting sensor into intelligent knee and hip replacements that will assess pH levels over time. By integrating these biosensors into intelligent implants, the early detection of joint replacement infections could be achieved, enhancing proactive intervention strategies.
- Publikační typ
- časopisecké články MeSH
- MeSH
- artralgie diagnóza etiologie terapie MeSH
- diferenciální diagnóza MeSH
- kolenní kloub * anatomie a histologie diagnostické zobrazování patologie MeSH
- lidé MeSH
- nemoci kloubů diagnóza patologie terapie MeSH
- prognóza MeSH
- rozsah kloubních pohybů MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- antibakteriální látky * terapeutické užití MeSH
- infekce chirurgické rány * terapie MeSH
- kostní hřeby využití MeSH
- lidé MeSH
- pseudoartróza * komplikace terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- MeSH
- biofilmy MeSH
- biosenzitivní techniky metody MeSH
- infekce spojené s protézou * diagnóza MeSH
- lidé MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
The reimplantation of a cemented femoral component at revision is always a challenge for the orthopaedic surgeon, particularly when the cement mantle is intact. The aim of this study was to provide evidence that the recementing of a femoral stem into the original cement mantle can be included in routine surgical procedures. MATERIAL AND METHODS: A group of 104 patients with femoral stem revision, followed-up for an average of 50.2 months, were retrospectively reviewed. The outcome evaluation was focused, in the first place, on survivorship of the femoral component, acetabular migration, and dislocation and infection after revision arthroplasty. Hip function evaluation was based on the Harris hip scores before surgery and at the latest follow-up. On radiographs Gruen zones were assessed pre-operatively and at the latest follow-up. The results were statistically evaluated using the Kaplan-Meier survival analysis (Statistica 8.0). RESULTS: Of the 104 patients, only three (2.9 %) had stem re-revision due to its loosening. Further 16 patients underwent revision for other post-operative complications. The success rate of reimplantation in our group including all post-operative complications was 81.7 %. The average Harris scores were 56 before surgery and 87 at the latest follow-up. Radiolucent lines in Gruen zones were on average 0.45 mm in width before revision and 0.15 mm at the latest follow-up. Fourteen patients had second revision within 20 months of the first and only five were revised after a long period. DISCUSSION: The cement-within-cement exchange of a femoral component is a relatively frequent orthopaedic procedure. Despite this frequency, however, there have not been enough literature reports based on large patient groups to give support to its routine use. The aim of this study was to demonstrate on a large patient group that recementing a femoral stem into the original intact cement mantle can be considered an established operative technique. Our results suggest that the list of indications for this technique, as described by Lieberman and Nelson, can be extended by the following: broken stem with an intact distal cement mantle, replacement of a monoblock femoral component due to severe head damage, loosening of the femoral component without impairment of the distal cement mantle, conversion of a cervico-capital to a total hip replacement and the need of removing all bone cement. No risk is associated with reimplantation of the original component if there is no need for a different implant to correct angle or length stability. A new implant is always used when any part of the femoral component has been damaged mechanically. If only the proximal stem requires recementing, the use of the original component is preferred because of absolute cement/stem cohesion. The number of our patients in which the technique failed was generally in agreement with the results of other authors. CONCLUSIONS: Utilisation of the original cement mantle of a femoral component is one of the options at revision arthroplasty. It requires rational considerations based on the type of surgery, state of the cement mantle, and type of material used for the femoral stem. The method is indicated preferably in the hips with an intact cement mantle treated for loosening of the acetabular component, recurrent dislocation or unequal leg-length in monoblock femoral components. In such situations the removal of well-fixed cement would also involve a considerable loss of bone tissue. The follow-up outcomes showed that the involvement of the cement-within-cement technique in routinely used surgical procedures is fully justified.
- MeSH
- cementování metody využití MeSH
- femur MeSH
- financování organizované MeSH
- interpretace statistických dat MeSH
- kostní cementy MeSH
- kyčelní protézy MeSH
- lidé středního věku MeSH
- lidé MeSH
- náhrada kyčelního kloubu MeSH
- reoperace metody MeSH
- retrospektivní studie MeSH
- selhání protézy MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statistika jako téma MeSH
- výsledek terapie MeSH
- výsledky a postupy - zhodnocení (zdravotní péče) MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- MeSH
- antibakteriální látky farmakologie terapeutické užití MeSH
- artroplastiky kloubů metody ošetřování využití MeSH
- chirurgie operační metody ošetřování využití MeSH
- financování organizované MeSH
- gynekologické chirurgické výkony metody ošetřování využití MeSH
- infekční nemoci etiologie přenos MeSH
- krevní nemoci etiologie prevence a kontrola MeSH
- lidé MeSH
- ortopedické výkony metody ošetřování využití MeSH
- piercing metody ošetřování škodlivé účinky MeSH
- pooperační komplikace prevence a kontrola MeSH
- porodnické chirurgické výkony metody ošetřování využití MeSH
- primární prevence metody MeSH
- rizikové faktory MeSH
- stomatologie metody MeSH
- urologické chirurgické výkony metody ošetřování využití MeSH
- Check Tag
- lidé MeSH
