Histological evaluation of periprosthetic infection using HOES scale and CD15 expression analysis at the stage of the hip revision arthroplasty

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Abstract

Background.The effectiveness improvement and standardization of the methods of histological diagnosing periprosthetic infection (PPI) is an urgent task in the treatment of complications after large joint arthroplasty. Purpose of the study— Histopathological evaluation of the infection involvement of periprosthetic tissues at the stage of revision arthroplasty for deep infection of the hip using HOES scale and immunohistochemical analysis of CD15 expression.

Materials and Methods.A single-center prospective study was performed on the clinical intraoperative material obtained at the stage of revision arthroplasty of the hip in 27 patients at the age of 65 (55÷69) years. The group of examination included patients with acute and chronic forms of deep periprosthetic infection. Light-optical microscopic investigation of the samples of periprosthetic connective-tissue membrane and bone tissue from the foci of infectious involvement was made on paraffin sections stained with hematoxylin and eosin; with the immunohistochemical reaction to determine the expression of CD15 neutrophil granulocyte markers. HOES Scale for pathohistological assessment was used in order to objectify osteomyelitis signs in periprosthetic bone tissue.

Results. The signs of acute and chronic stages of periprosthetic osteomyelitis were observed in 9/16 patients with PPI chronic course within 1–30 months of postoperative period, from one to 18 months after manifestation of the symptoms. The signs of subsided osteomyelitis were determined in 12/27 patients with PPI of acute and chronic forms. Infected periprosthetic membranes were found in 19/27 clinical cases in the early and longterm  time  periods  after  arthroplasty  surgery.  A  direct  significant  correlation  was  revealed  between  histopathological signs  of  infecting  the  periprosthetic  bone  and  the  connective-tissue  periprosthetic  membrane,  especially  strong  one in  patients  with  acute  and  chronic  PPI  osteomyelitis.

Conclusion. The  use  of  HOES  Scale  and  the  analysis  of  CD15 expression  ensure  the  objectivity  of  PPI  histological  diagnosing.  The  results  obtained  indicate  an  increased  risk  of osteomyelitis development in patients with chronic periprosthetic infection after the hip arthroplasty.

About the authors

T. A. Silanteva

FSBI «National Ilizarov Medical Research Centre for Traumatology and Ortopaedics» Ministry Healthcare

Author for correspondence.
Email: tsyl@mail.ru
ORCID iD: 0000-0001-6405-8365
http://www.ilizarov.ru/

Tamara A. Silantieva— Cand. Sci. (Biol.)

Kurgan

Russian Federation

A. M. Ermakov

FSBI «National Ilizarov Medical Research Centre for Traumatology and Ortopaedics» Ministry Healthcare

Email: tsyl@mail.ru
ORCID iD: 0000-0002-5420-4637
http://www.ilizarov.ru/

Artem M. Ermakov— Cand. Sci. (Med.)

Kurgan

Russian Federation

A. S. Tryapichnikov

FSBI «National Ilizarov Medical Research Centre for Traumatology and Ortopaedics» Ministry Healthcare

Email: pich86@bk.ru
ORCID iD: 0000-0001-7305-506X
http://www.ilizarov.ru/

Aleksandr S. Tryapichnikov— Cand. Sci. (Med.)

Kurgan

Russian Federation

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