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
Záchranné operace vyžadují menší či větší kompromis. Proto je nejlepším řešením komplikací náhrady kolena jejich prevence, tedy úspěšná primoimplantace nebo první reimplantace, kdy využijeme vše, co současná medicína nabízí, a především dodržíme pravidla. Chronická supresivní antibiotická terapie je možným řešením pro nemocné, kteří by operaci a následnou léčbu nezvládli. Resekční artroplastika po extrakci revizní náhrady kolena vede k výrazné nestabilitě, jež je obtížně řešitelná i nošením ortézy. Kontaktní artrodéza kolenního kloubu nemá vzhledem k výraznému zkratu končetiny ideální funkční výsledky. Preferujeme distanční artrodézu. Život je pro pacienta s artrodézou jednodušší než po amputaci či resekční plastice. Artrodéza umožňuje pacientovi nezávislý životní styl s několika omezeními, především nemožností skrčit koleno. Na druhou stranu je pro život lepší koleno bez pohybu než amputace nad kolenem. Amputace je posledním řešením komplikací kloubních náhrad kolena, řešením náročným pro nemocného psychicky, ale i fyzicky.
Salvage/rescue procedures always require compromises. The best solution for knee replacement complications is prevention, or a successful primary implantation or first exchange arthroplasty, where we use everything what modern medicine offers and most importantly we are able to follow normal recommended procedures. Chronic suppressive antibiotic therapy is a possible solution for patients who could not handle the surgery and subsequent treatment. Resection arthroplasty after extraction of knee replacement revision leads to significant instability which is difficult to deal with, even while wearing a brace. Knee joint contact arthrodesis does not have ideal functional results due to significant limb shortening. We thus prefer non-contact arthrodesis. Life is easier for patients with arthrodesis than for patients who have to undergo amputation or resection arthroplasty. Arthrodesis allows the patient an independent lifestyle some restrictions, especially the inability to bend the knee. Life with an immobile knee is better however than amputation above the knee. Amputation is the last resort solution for knee joint replacements complications, a solution which is difficult for the patient both mentally and physically.
- Klíčová slova
- resekční artroplastika,
- MeSH
- amputace MeSH
- artrodéza metody přístrojové vybavení MeSH
- artroplastika MeSH
- hodnocení rizik MeSH
- infekce spojené s protézou * farmakoterapie chirurgie MeSH
- lidé MeSH
- neúspěšná terapie MeSH
- ortopedické výkony metody přístrojové vybavení MeSH
- pooperační komplikace MeSH
- reoperace MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- záchrana končetiny * metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
- přehledy MeSH
In our prospective study, we examined whether a multiplex PCR diagnostic method is suitable for the primary detection of pathogens. We also examined the possibility and sensitivity of detecting genes responsible for biofilm production and methicillin resistance. From 2007 to 2009, 94 patients were included in the study. A UNB (universal detection of 16S ribosomal bacterial DNA) and UNF (universal detection of pathogenic fungi) were used in the primary detection. A multiplex assay for biofilm production, methicillin resistance allowed us to distinguish between Gram positivity and negativity and to detect Staphylococci. From all the samples, the culture was positive in 53.2 % of cases, and by using the UNB method, we detected bacteria in 79.8 % of cases-the UNF detection of fungi was positive in 10.6 % of cases. In 75 % of positive findings, we detected a Gram-negative bacterium in 65.3 % of cases. In 47.2 % of Staphylococci detected, the ability to produce biofilm was confirmed. 61.1 % of the Staphylococci exhibited a methicillin resistance. Our multiplex scheme cannot yet fully replace microbial cultivation but can be a rational guide when choosing an appropriate antibiotic therapy in cases where the microbial culture is negative.
- MeSH
- bakteriální proteiny genetika MeSH
- dospělí MeSH
- gramnegativní bakteriální infekce diagnóza mikrobiologie MeSH
- gramnegativní bakterie genetika izolace a purifikace MeSH
- infekce spojené s protézou diagnóza mikrobiologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- multiplexová polymerázová řetězová reakce metody MeSH
- prospektivní studie MeSH
- protézy kloubů mikrobiologie MeSH
- senioři MeSH
- stafylokokové infekce diagnóza mikrobiologie MeSH
- Staphylococcus klasifikace genetika izolace a purifikace MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- hodnotící studie MeSH
- práce podpořená grantem MeSH
BACKGROUND: The topical application of Vancomycin is increasingly being used in orthopedics because of the development of methicillin resistant bacteria. Consequently, resistance to Vancomycin has recently been on the rise. One possible explanation for this phenomenon could be the thermal degradation of Vancomycin to antibacterially inactive crystalline degradation products (CDP-1s). The aim of our in vitro experiment was to compare the creation and elution characteristics of CDP-1s and the active form of Vancomycin (factor B) released from bone grafts. METHODS: CDP-1s and the factor B released from bone grafts into the buffer solution were measured using the high-performance liquid chromatography method at progressive intervals. RESULTS: The factor B was released from bone grafts at the highest levels, typically on the first day (618.8 mg/L). CDP-1 levels kept increasing until the end of measurement on day 15, when the concentration of CDP-1s (1280.7 mg/L) was much higher compared to that of factor B (217.5 mg/L). CONCLUSIONS: We confirmed the tendency of Vancomycin to convert to antimicrobially ineffective CDP-1s. Although Vancomycin is decomposed into crystalline degradation products, its active forms are released from bone grafts in sufficient concentration for more than two keks (Tab. 3, Fig. 1, Ref. 15).
- MeSH
- antibakteriální látky aplikace a dávkování farmakologie chemie MeSH
- krystalizace MeSH
- lidé MeSH
- nosiče léků * MeSH
- osteomyelitida * MeSH
- techniky in vitro MeSH
- transplantace kostí MeSH
- vankomycin aplikace a dávkování farmakologie chemie MeSH
- vysokoúčinná kapalinová chromatografie MeSH
- Check Tag
- lidé 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
- MeSH
- antibakteriální látky terapeutické užití MeSH
- artroplastika využití MeSH
- infekce spojené s protézou * farmakoterapie chirurgie terapie MeSH
- lidé MeSH
- replantace metody využití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- práce podpořená grantem MeSH
