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

Cover Page

Cite item


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

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


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

Artem M. Ermakov— Cand. Sci. (Med.)


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

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


Russian Federation


  1. Sharkey P.F., Lichstein P.M., Shen C., Tokarski A.T., Parvizi J. Why are total knee arthroplasties failing today--has anything changed after 10 years? J Arthroplasty. 2014; 29(9):1774-8. doi: 10.1016/j.arth.2013.07.024.
  2. Zhang T., Zheng C., Ma H., Sun C. Causes of early failure after total hip arthroplasty. Zhonghua Yi Xue Za Zhi. 2014;94(48):3836-8. doi: 10.3760/cma.j.issn.0376-2491.2014.48.011.
  3. Masters E.A., Trombetta R.P., de Mesy Bentley K.L., Boyce B.F., Gill A.L., Gill S.R. et al. Evolving concepts in bone infection: redefining "biofilm", "acute vs. chronic osteomyelitis", "the immune proteome" and "local antibiotic therapy". Bone Res. 2019;(7):20. doi: 10.1038/s41413-019-0061-z.eCollection 2019.
  4. Губин А.В., Клюшин Н.М. Проблемы организации лечения больных хроническим остеомиелитом и пути их решения на примере создания клиники гнойной остеологии. Гений ортопедии. 2019;25(2):140-148. doi: 10.18019/1028-4427-2019-25-2-140-148.
  5. Kurtz S.M., Lau E.C., Son M.S., Chang E.T., Zimmerli W., Parvizi J. Are We Winning or Losing the Battle With Periprosthetic Joint Infection: Trends in Periprosthetic Joint Infection and Mortality Risk for the Medicare Population. J Arthroplasty. 2018;33(10):3238-3245. doi: 10.1016/j.arth.2018.05.042.
  6. Kapadia B.H., Berg R.A., Daley J.A., Fritz J., Bhave A., Mont M.A. Periprosthetic joint infection. Lancet. 2016;387(10016):386-394. doi: 10.1016/S0140-6736(14)61798-0.
  7. Винклер Т., Трампуш А., Ренц Н., Перка К., Божкова С.А. Классификация и алгоритм диагностики и лечения перипротезной инфекции тазобедренного сустава. Травматология и ортопедия России. 2016;(1):33-45.doi: 10.21823/2311-2905-2016-0-1-33-45.
  8. Клюшин Н.М., Шляхов В.И., Чакушиш Б.Э, Злобин А.В., Бурнашов С.И., Абабков Ю.В. с соавт. Чрескостный остеосинтез в лечении больных хроническим остеомиелитом после эндопротезирования крупных суставов. Гений ортопедии.2010; (2):37-43.
  9. Natsuhara K.M., Shelton T.J., Meehan J.P., Lum Z.C. Mortality during total hip periprosthetic joint infection. J Arthroplasty. 2019;34(7S):S337-42. doi: 10.1016/j.arth.2018.08.021.
  10. Birt M.C., Anderson D.W., Toby E.B., Wang J. Osteomyelitis: Recent advances in pathophysiology and therapeutic strategies. J Orthop. 2016;14(1):45-52. doi: 10.1016/j.jor.2016.10.004.
  11. Брико Н.И., Божкова С.А., Брусина Е.Б., Жедаева М.В., Зубарева Н.А., Зуева Л.П. с соавт. Профилактика инфекций области хирургического вмешательства, 2018 Клинические рекомендации. Н. Новгород: Ремедиум Приволжье, 2018. 72с. doi: 10.21145/Clinical_Guidelines_NASKI_2018.
  12. Panteli M., Giannoudis P.V. Chronic osteomyelitis: what the surgeon needs to know. EFORT Open Rev. 2017;1(5):128-135. doi: 10.1302/2058-5241.1.000017.
  13. Morawietz L., Krenn V. Das Spektrum histopathologischer Veränderungen in endoprothetisch versorgten Gelenken. Pathologe. 2014;35:218-224. doi: 10.1007/s00292-014-1976-1.
  14. Pellegrini A., Legnani C., Meani E. A new perspective on current prosthetic joint infection classifications: introducing topography as a key factor affecting treatment strategy. Arch Orthop Trauma Surg. 2019;139(3):317-322. doi: 10.1007/s00402-018-3058-y.
  15. Кренн Ф., Колбель Б., Винерт С., Димитриадис Ж., Кендоф Д., Герке Т. с соавт. Новый алгоритм гистопатологической диагностики перипротезной инфекции с применением шкалы CD15 focus score и компьютерной программы CD15 Quantifier. Травматология и ортопедия России. 2015;(3):76-85. doi: 10.21823/2311-2905-2015-0-3-76-85.
  16. Parvizi J., Tan T.L., Goswami K., Higuera C., Della Valle C., Chen A.F. et al. The 2018 definition of periprosthetic hip and knee infection: an evidence-based and validated criteria. J Arthroplasty. 2018;33:1309–1314.e2. doi: 10.1016/j.arth.2018.02.078.
  17. Krenn V.T., Liebisch M., Kölbel B., Renz N., Gehrke T., Huber M. et al. CD15 focus score: Infection diagnosis and stratification into low-virulence and high-virulence microbial pathogens in periprosthetic joint infection. Pathol Res Pract. 2017;213(5):541-547. doi: 10.1016/j.prp.2017.01.002.
  18. Haaker R., Senge A., Krämer J., Rubenthaler F. Osteomyelitis nach Endoprothesen. Orthopäde. 2004;33:431-438. doi: 10.1007/s00132-003-0624-x.
  19. Hung D.Z., Tien N., Lin C.L., Lee Y.R., Wang C.C., Chen J.J. et al. Increased risk of chronic osteomyelitis after hip replacement: a retrospective population-based cohort study in an Asian population. Eur J Clin Microbiol Infect Dis. 2017;(4):611-617. doi: 10.1007/s10096-016-2836-0.
  20. Tiemann A., Hofmann G.O., Krukemeyer M.G., Krenn V., Langwald S. Histopathological Osteomyelitis Evaluation Score (HOES) – an innovative approach to histopathological diagnostics and scoring of osteomyelitis. GMS Interdiscip Plast Reconstr Surg DGPW. 2014;3:Doc08. doi: 10.3205/iprs000049.
  21. Stupina T.A., Sudnitsyn A.S., Subramanyam K.N., Migalkin N.S., Kirsanova A.Y., Umerjikar S. Applicability of histopathological osteomyelitis evaluation score (HOES) in chronic osteomyelitis of the foot - A feasibility study. Foot Ankle Surg. 2020;26(3):273-279. doi: 10.1016/j.fas.2019.03.008.
  22. Boettner F., Koehler G., Wegner A., Schmidt-Braekling T., Gosheger G., Goetze C. The Rule of Histology in the Diagnosis of Periprosthetic Infection: Specific Granulocyte Counting Methods and New Immunohistologic Staining Techniques may Increase the Diagnostic Value. Open Orthop J. 2016;10:457-465. doi: 10.2174/1874325001610010457.
  23. Porrino J., Wang A., Moats A., Mulcahy H., Kani K. Prosthetic joint infections: diagnosis, management, and complications of the two-stage replacement arthroplasty. Skeletal Radiol. 2020;49:847-859. doi: 10.1007/s00256-020-03389-w.
  24. Baker R.P., FurustrandTafin U., Borens O. Patient-adapted treatment for prosthetic hip joint infection. Hip Int. 2015;25(4):316-22. doi: 10.5301/hipint.5000277.
  25. Zimmerli W. Clinical presentation and treatment of orthopaedic implant-associated infection. J. Intern. Med. 2014;276(2):111-9. doi: 10.1111/joim.12233.
  26. Li C., Renz N., Trampuz A. Management of Periprosthetic Joint Infection. Hip Pelvis. 2018;30(3):138-146. doi: 10.5371/hp.2018.30.3.138.
  27. Tsukayama D.T., Estrada R., Gustilo R.B. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78(4):512-523. doi: 10.2106/00004623-199604000-00005.
  28. Bauer T.W., Zhang Y. Implants and implant reactions. Diagnostic Histopathology. 2016;22(10):384-396. doi: 10.1016/j.mpdhp.2016.09.001.
  29. Krenn V., Morawietz L., Perino G., Kienapfel H., Ascherl R., Hassenpflug G.J.et al. Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract. 2014;210(12):779-86. doi: 10.1016/j.prp.2014.09.017.
  30. Perino G., Sunitsch S., Huber M., Ramirez D., Gallo J., Vaculova J. et al. Diagnostic guidelines for the histological particle algorithm in the periprosthetic neo-synovial tissue. BMC Clin Pathol. 2018;18:7. doi: 10.1186/s12907-018-0074-3.
  31. Мидлтон М.Р. Анализ статистических данных с использованием Microsoft Excel для Office XP. Пер. с англ.; Под ред. Г.М. Кобелькова. М.: БИНОМ, Лаборатория знаний. 2005. 296 с.
  32. Гржибовский А.М., Горбатова М.А., Наркевич А.Н., Виноградов К.А. Объем выборки для корреляционного анализа. Морская медицина. 2020 ;6(1);101-106. doi: 10.22328/2413-5747-2020-6-1-101-106.
  33. Krenn V., Perino G. Histological Diagnosis of Implant-Associated Pathologies. Germany: Springer-Verlag Berlin Heidelberg; 2017. 41 p. doi: 10.1007/978-3-662-54204-0_1.
  34. Fink B., Gebhard A., Fuerst M., Berger I., Schafer P. High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip. Clin Orthop Relat Res. 2013;471(3):956-964. doi: 10.1007/s11999-012-2474-5.
  35. Enz A., Becker J., Warnke P., Prall F., Lutter C., Mittelmeier W. et al. Increased Diagnostic Certainty of Periprosthetic Joint Infections by Combining Microbiological Results with Histopathological Samples Gained via a Minimally Invasive Punching Technique. J Clin Med. 2020;9(10):3364. doi: 10.3390/jcm9103364.
  36. Abdelaziz H, Rademacher K, Suero EM, Gehrke T, Lausmann C, Salber J, Citak M. The 2018 International Consensus Meeting Minor Criteria for Chronic Hip and Knee Periprosthetic Joint Infection: Validation From a Single Center. J Arthroplasty. 2020 Aug;35(8):2200-2203. doi: 10.1016/j.arth.2020.03.014.
  37. Tande A.J., Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302-345. doi: 10.1128/CMR.00111-13.
  38. Казанцев Д.И., Божкова С.А., Золовкина А.Г., Пелеганчук В.А., Батрак Ю.М. Диагностика поздней перипротезной инфекции крупных суставов. Какой диагностический алгоритм выбрать? Травматология и ортопедия России. 2020;26(4):9-20. https://doi.org/10.21823/2311-2905-2020-26-4-9-20.
  39. Ермаков А.М., Клюшин Н.М., Абабков Ю.В., Тряпичников А.С., Коюшков А.Н. Оценка эффективности двухэтапного хирургического лечения больных с перипротезной инфекцией коленного и тазобедренного суставов. Гений Ортопедии. 2018;24(3):321-326. doi: 10.18019/1028-4427-2018-24-3-321-326.

Supplementary files

There are no supplementary files to display.

Copyright (c)

СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 82474 от 10.12.2021.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies