[Routine preoperative examination for diagnosis of periprosthetic joint infection and its recurrence in revision hip arthroplasty]. / Rol' rutinnogo dooperatsionnogo obsledovaniya v vyyavlenii periproteznoi infektsii i ee retsidiva pri revizionnom endoprotezirovanii tazobedrennogo sustava.

OBJECTIVE: To evaluate diagnostic value of routine preoperative laboratory tests such as erythrocyte sedimentation rate (ESR), serum C-reactive protein (CRP) and microbiological examination of joint aspirate in patients with periprosthetic joint infection or its recurrence in patients scheduled for revision hip arthroplasty. MATERIAL AND METHODS: There were 117 patients. Preoperative CRP and ESR, the culture of pre- and intraoperative joint aspirates and tissue biopsies were studied. We analyzed diagnostic significance of these parameters and the likelihood of periprosthetic joint infection depending on increase of CRP/ESR and previous joint infection. RESULTS: According to microbiological data, periprosthetic joint infection was diagnosed in 19.7% of patients. High CRP in this group significantly increased the chance of joint infection diagnosis (OR 6.3; 95% CI 1.491-26.615). Concomitant increase of both ESR and CRP increased this likelihood by 7.7 times (OR 7.778; 95% CI 0.931-66.296). In the 2nd group, periprosthetic joint infection was confirmed in 25% of patients. At the same time, detection of pathogen in isolated or combined increase in CRP and ESR was less likely compared to the control group. Prognostic value of negative preoperative microbiological examination of joint aspirate was only 93%. We failed to obtain aspirate in 21.4% of cases. CONCLUSION: Increase of the routine serological parameters before revision hip arthroplasty is more sensitive for prediction of periprosthetic joint infection in patients without previous infection. Previous joint infection reduces diagnostic value of ESR and CRP in detection of recurrent periprosthetic joint infection. Preoperative examination of joint aspirate is not sufficient for etiological diagnosis of periprosthetic joint infection. However, positive microbiological culture should be taken into account for the choice of further management.

[Resection Arthroplasty Using a Vastus Lateralis Muscle Flap in the treatment of patients with recurrent form of the hip prosthetic joint infection]. / Rezektsionnaia artroplastika s peresadkoi ostrovkovogo myshechnogo loskuta u bol'nykh s periproteznoi infektsiei.

OBJECTIVE: To evaluate the efficacy of chronic recurrent hip periprosthetic joint infection (PJI) eradication after resection arthroplasty with non-free transplantation of vastus lateralis muscle flap of the thigh. MATERIAL AND METHODS: There were 38 patients with chronic recurrent hip PJI who underwent resection arthroplasty with non-free transplantation of vastus lateralis muscle flap of the thigh in 2005-2016. The groups were compiled considering the absence or presence of recurrent infection in early postoperative period. Infection duration, number of operations, incidence of recurrent PJI, type of pathogen, laboratory parameters, bone defect size and presence of PJI remission within at least 2 years were investigated. RESULTS: Uneventful early postoperative period after resection arthroplasty with non-free transplantation of vastus lateralis muscle flap was noted in 81.6% of cases (n=31, group 1). Postoperative wound revision was required in 18.4% of cases (n=7, group 2). Stable remission of infection within 2-8 years (Me - 4 years) was achieved in 36 (94.7%) patients. Relative risk of recurrent PJI increased by more than 4 times (RR 4,364, 95% CI 0,581-32,787) in cases of polymicrobial infection involving Gram-negative bacteria and decreased in cases of monomicrobial infection (RR 0,256, 95% CI 0,034-1,916). Significantly longer duration of surgery and more pronounced laboratory changes were revealed in group 2. CONCLUSION: High efficacy of resection arthroplasty with non-free transplantation of vastus lateralis muscle flap of the thigh was established in patients with chronic recurrent hip PJI. This procedure might be considered as a stage treatment with the possibility for revision arthroplasty in case of failed initial debridement surgery due to PJI pathogens that are difficult for eradication.

[PERIFOCAL TISSUE REACTIONS TO IMPLANTATION OF THE SAMPLES OF HYDROGEL MATERIAL BASED ON POLYACRYLAMIDE WITH THE ADDITION OF THE CELLULOSE (AN EXPERIMENTAL STUDY)].

Tissue reactions to the grafting of samples of composite hydrogel based on polyacrylamide and cellulose of different origin (plant and bacterial) were studied in 48 laboratory outbred rats and 24 rabbits of chinchilla breed. The observations were carried out on Days 5, 14, 45 and 90 after placement of implants in the muscle, joint cavity, deep defects of the articular cartilage and subchondral bone. The study has revealed no migration and degradation of the samples. On Day 90, the signs of their biointegration (regardless of their nature) were detected in the muscles and in one case (the sample containing bacterial cellulose) in the cavity of the knee joint of the rat. The materials had good biocompatibility with muscle, cartilage and bone tissues, did not cause perifocal inflammation and effectively functioned as a prosthetic articular cartilage until the end of the study period.