PURPOSE OF THE STUDY This study deals with the possibilities and application of immunohistochemical methods to detect mast and dendritic cells in periprosthetic tissues in patients with aseptically loosened total joint replacements of the knee and hip. The purpose of the study was to quantify and characterize the distribution of mast and dendritic cells in the examined samples and to study the statistically significant relations between the aforementioned cell populations and selected parameters characterizing the patients, implants or tissue response. Based on the proved findings, a possible relation between mast and dendritic cells and histomorphological patterns of aseptic loosening and the benefit of the applied immunohistochemical methods was evaluated. MATERIAL AND METHODS Periprosthetic tissues from a total of 31 patients (17 patients after a revision surgery of hip prosthesis, 14 patients after a revision surgery of knee prosthesis) were examined. The collected samples were processed according to the standard protocol for the purposes of histological and immunochemical examination. Antibodies against tryptase and CD117 were used for immunohistochemical detection of mast cells. Dendritic cells were detected by means of S100 and CD1a antibodies. Quantification of both the cell populations was carried out by optical microscopy in 20 high power fields at 400-times magnification. From among the applied methods we picked the more sensitive one for statistical evaluation. It was tryptase in the case of mast cells and S100 in the case of dendritic cells. RESULTS Mast and dendritic cells were mostly distributed dispersively in periprosthetic tissues; however, they also occurred in groups perivasally or near necrotic parts. The examined samples showed the presence of 60 mast cells and 50 dendritic cells on average. The increased density of mast and dendritic cells was associated with polypously formed pseudosynovium and cement fixation of prostheses; this relation was statistically significant. It was impossible to prove the correlation between the quantity of the observed cell populations and the nature and the number of the observed particles because wear particles were present dispersely in all the samples. Another statistically significant relation to the type of material or implant fixation or other examined histomorphological patterns was not proved. A strong density of mast cells with a minimum presence of dendritic cells was observed in the control patient group. DISCUSSION The differences in density of S100 positive dendritic cells between the control and examined group of patients can be caused by the activation of dendritic cells by exogenous or endogenous pathways of immune processes going on after the implantation of endoprosthesis. The statistically significant interrelation of mast cells, polypously formed pseudosynovium and cement wear particles can be explained at least in part as a tissue reaction induced by cement particles. CONCLUSIONS We proved the presence of two immunologically significant cell populations in periprosthetic tissues. The said findings indicate a conclusion of significant functional participation of mast and dendritic cells in pathogenesis of aseptic loosening and periprosthetic osteolysis. Nevertheless, this will have to be proved in another way and with the use of another method. Key words:dendritic cells, mast cells, aseptic loosening, total joint replacement, immune reaction, adverse reaction.
- MeSH
- antigeny CD1 imunologie MeSH
- dendritické buňky imunologie ultrastruktura MeSH
- kolenní kloub mikrobiologie patologie chirurgie MeSH
- kyčelní kloub mikrobiologie patologie chirurgie MeSH
- kyčelní protézy škodlivé účinky mikrobiologie MeSH
- lidé MeSH
- mastocyty imunologie ultrastruktura MeSH
- mikroskopie přístrojové vybavení MeSH
- proteiny S100 imunologie MeSH
- protézy kolene škodlivé účinky mikrobiologie MeSH
- protoonkogenní proteiny c-kit imunologie MeSH
- reoperace metody MeSH
- selhání protézy škodlivé účinky MeSH
- tryptasy imunologie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
BACKGROUND AND AIM: The aim of this study was to evaluate the characteristics of synovial fluid (SF) white cell count (SWCC) and neutrophil/lymphocyte percentage in the diagnosis of prosthetic joint infection (PJI) for particular threshold values. METHODS AND RESULTS: This was a prospective study of 391 patients in whom SF specimens were collected before total joint replacement revisions. SF was aspirated before joint capsule incision. The PJI diagnosis was based only on non-SF data. Receiver operating characteristic plots were constructed for the SWCC and differential counts of leukocytes in aspirated fluid. Logistic binomic regression was used to distinguish infected and non-infected cases in the combined data. PJI was diagnosed in 78 patients, and aseptic revision in 313 patients. The areas (AUC) under the curve for the SWCC, the neutrophil and lymphocyte percentages were 0.974, 0.962, and 0.951, respectively. The optimal cut-off for PJI was 3,450 cells/μL, 74.6% neutrophils, and 14.6% lymphocytes. Positive likelihood ratios for the SWCC, neutrophil and lymphocyte percentages were 19.0, 10.4, and 9.5, respectively. Negative likelihood ratios for the SWCC, neutrophil and lymphocyte percentages were 0.06, 0.076, and 0.092, respectively. CONCLUSIONS: Based on AUC, the present study identified cut-off values for the SWCC and differential leukocyte count for the diagnosis of PJI. The likelihood ratio for positive/negative SWCCs can significantly change the pre-test probability of PJI.
- MeSH
- biologické markery metabolismus MeSH
- infekce spojené s protézou diagnóza MeSH
- kyčelní protézy škodlivé účinky mikrobiologie MeSH
- leukocyty metabolismus MeSH
- lidé MeSH
- náhrada kyčelního kloubu * škodlivé účinky MeSH
- neutrofily metabolismus MeSH
- plocha pod křivkou MeSH
- prediktivní hodnota testů MeSH
- prospektivní studie MeSH
- protézy kolene škodlivé účinky mikrobiologie MeSH
- senioři MeSH
- senzitivita a specificita MeSH
- synoviální tekutina cytologie MeSH
- totální endoprotéza kolene * škodlivé účinky MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
PURPOSE OF THE STUDY The study presents the monocentric retrospective study of a group of patients with malignant tumours around the knee, treated by a wide resection and a reconstruction with megaprosthesis due to infectious complications. Provided is a detailed analysis of each operative treatment due to the manifestation and process of periprostethic infection of the knee megaprosthesis and the use of external fixator during a two-stage revision. MATERIAL AND METHODS Between 01/1993 and 12/2013, a total of 67 cemented megaprostheses were assessed, with a detailed analysis of 12 patients with periprosthetic infection. The Kaplan-Meier method and MSTS for lower extremity clinical assessment were used and a range of motion was evaluated. RESULTS The endoprosthesis failed due to all kinds of complications (mechanical, biological, infection) in 27 (40.3%) patients. The estimated one-year survival rate from the surgery was 94%, the five-year survival rate was 72%, and the ten-year survival rate was 46%. Based on the statistical analysis of the implant survival due to infection, the one-year survival rate was 94%, the five-year survival rate was 75%, and the ten-year survival rate was 57%. Three patients were treated with radical surgical debridement. Five patients were treated with a two-stage revision with a cement spacer and external fixator, and three patients underwent nail fixation. Clinical values before and two years after the revision surgery for periprosthetic infection using MSTS were assessed. The mean of the difference of clinical values was 1.91 and the p value of paired t-test was 0.24, therefore there was no prove of the clinical result difference using MSTS before and after the revision surgery. DISCUSSION The acute radical debridement and lavage is preferred, if the surgery can be done up to three weeks after the first clinical signs of infection under the condition of good retention of the implant. In case of extensive infectious damage, when abscess, fistula and loosening of the implant are present and when the patient has a good oncological prognosis, we prefer a twostage revision with a cement spacer stabilized by an external fixator. In patients with mitigated infection or uncertain oncological prognosis we prefer a two-stage revision with the combination of a cement spacer and intramedullary nail fixation. CONCLUSIONS The study presents the results of operative treatment of periprosthetic infection of megaprosthesis and the modification of the two-stage replantation of infected MP with the use of external fixation for stabilisation of a non-articulated cement spacer allowing the patient to remain active during the time before the second stage. Key words: periprosthetic infection, megaprosthesis, bone tumour, external fixator, two-stage revision.
- MeSH
- analýza přežití MeSH
- debridement metody MeSH
- kolenní kloub mikrobiologie patologie chirurgie MeSH
- lidé MeSH
- nádory kostí mikrobiologie patologie chirurgie MeSH
- protézy kolene mikrobiologie MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- selhání protézy MeSH
- totální endoprotéza kolene škodlivé účinky přístrojové vybavení metody MeSH
- vnitřní fixace fraktury metody MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
Úvod: Peroperační diagnostika periprotetického infektu je principiálně založena na potvrzení předoperační diagnózy a identifikaci mikrobiálního agens nebo jeho ověření z předchozích vyšetření. Úspěšnost terapie monitorací zánětlivé aktivity je hodnocena pomocí laboratorních hodnot /C-reaktivní protein (CRP), počet leukocytů (WBC), sedimentace (FW), event. Interleukin-6 (Il-6)/. Materiál a metoda: V rámci retrospektivní studie v letech 10/2008–1/2011 byl hodnocen soubor pacientů operovaných pro infekt TEP. Celkově bylo operováno 20 pacientů (10 mužů, 10 žen) o průměrném věku 64,3 let. V hodnoceném souboru pacientů s infektem TEP byl operován celkem 10x kyčelní kloub (50 %), 10x kolenní kloub (50 %). Ke klasifikaci bylo na základě anamnézy a průběhu onemocnění použito Coventryho rozdělení: časný pooperační infekt 3x (15 %), pozdní pooperační infekt 12x (60 %), hematogenní infekt 5x (25 %). Výsledky: Pozitivní kultivační nález byl zaznamenán v rámci předoperačních vyšetření u 8 pacientů (40 %), peroperační kultivační vyšetření tekutiny nebo tkáně oblasti TEP u celkem 11 pacientů (55 %), peroperační stěr z povrchu TEP u 8 pacientů (40 %) a metodou sonikace u 15 pacientů (75 %). Celkově byla naměřena hodnota CRP předoperačně 88,2, první den pooperačně 99,54, první týden pooperačně 41,5, šest týdnů pooperačně 17,9. WBC dosáhlo hodnot předoperačně 8,7, první den pooperačně 9,8, první týden pooperačně 6,28, šest týdnů pooperačně 6,91. Diskuze: Hodnocení našeho souboru prokazuje vyšší úspěšnost získání bakteriálního agens metodou sonikace než u ostatních kultivačních metod. Studie dále hodnotila CRP a WBC peroperačně. Výsledky potvrzují CRP, jako citlivější marker monitorace infektu, než WBC. Rozptyl obou měřených hodnot lze vysvětlit relativní heterogenitou hodnocené skupiny pacientů v rámci aktivity infektu (časný – akutní, pozdní – chronický).
Introduction: The perioperative analysis of periprosthetic infection is principally based upon the verification of the preoperative diagnosis and the identification of the microbial agent or its confirmation. The success of the operative therapy is assessed by means of monitoring laboratory tests (CRP, WBC, FW, Il-6). Material and Method: The 10/2008 – 1/2011 retrospective study assessed a group of the patients operated for a THR or TKR periprosthetic infection. The studied group included 20 patients (10 males, 10 females) of the average age of 64.3 years. A revision surgery was conducted for 10 THR and 10 TKR periprosthetic infections. The authors used the Coventry classification: early postoperative: 3 cases, late postoperative: 12 cases, haematogenous: 5 cases. Results: The authors detected 8 positive microbial results in preoperative testing, 11 positive microbial agents in fluid or tissue samples, 8 positive results in endoprosthesis cultivation and 15 positive results from intraoperative sonication testing. Furthermore, the average measured CRP values were: 88.2 preoperatively, 99.54 on Day 1 after surgery, 41.5 at Week 1 after surgery, and 17.9 at Week 6 after surgery. WBC values were as follows: 8.7 preoperatively, 9.8 on Day 1 after surgery, 6.28 at Week 1 after surgery, and 6.91 at Week 6 after surgery. Discussion: The retrospective study indicates a higher success rate in obtaining the positive bacterial agent via the sonication technique compared to other microbiological methods. The study also assessed the CRP and WBC values during the periprosthetic infection therapy. The laboratory test results indicate that CRP is a more sensitive marker of infection than WBC. The heterogeneity of the studied patient group (acute, late infection) could be the explanation of the CRP and WBC value variance.
- Klíčová slova
- sonikace, endoprotéza, mikrobiologické vyšetření, CRP,
- MeSH
- bakteriální infekce diagnóza mikrobiologie MeSH
- C-reaktivní protein analýza MeSH
- časná diagnóza MeSH
- dospělí MeSH
- histologické techniky MeSH
- infekce spojené s protézou diagnóza mikrobiologie MeSH
- kyčelní protézy mikrobiologie škodlivé účinky MeSH
- lidé středního věku MeSH
- lidé MeSH
- mikrobiologické techniky MeSH
- mladý dospělý MeSH
- náhrada kyčelního kloubu škodlivé účinky MeSH
- peroperační péče MeSH
- počet lymfocytů statistika a číselné údaje MeSH
- pooperační péče MeSH
- protézy kolene mikrobiologie škodlivé účinky MeSH
- reoperace MeSH
- retrospektivní studie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- totální endoprotéza kolene škodlivé účinky MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
A rare case of a severe prosthetic joint infection in a 71-year-old immunocompetent woman is presented. Listeria monocytogenes was identified in two consecutive samples using broad-range PCR and sequencing, whereas cultivation remained negative for the first sample and streptococci of a non-group A streptococci, non-group B streptococci type were detected for the second one. This report demonstrates that the phenotypic approach may lead to misidentification of L. monocytogenes in a routine clinical setting. Molecular methods of pathogen detection might be useful when a rare and/or unexpected micro-organism is present or the sample is collected during antibiotic treatment.
- MeSH
- DNA bakterií analýza MeSH
- fenotyp MeSH
- genotyp MeSH
- infekce spojené s protézou diagnóza mikrobiologie MeSH
- kultivační média MeSH
- lidé MeSH
- Listeria monocytogenes fyziologie genetika izolace a purifikace klasifikace MeSH
- listeriové infekce diagnóza mikrobiologie MeSH
- polymerázová řetězová reakce MeSH
- protézy kolene mikrobiologie MeSH
- sekvenční analýza DNA MeSH
- senioři MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
