Protez Enfeksiyonunu Tanımlamak İçin Spesifik Parametrelerin Eklemden Alınan Sıvıda Bakılması

Abstract

Total joint arthroplasty in one of the most performed surgiries in the past decades and its effectiveness and patient satisfaction had been approved. Neverthless, complications of this procedure is one of the most challenging situation in orthopedadic practice. Contrary to other surgical fields, infection in total joint arhroplasty is silent and hard to diagnose most times. Discrimination of septic and aseptic loosening is another challenging issue. In present orthopeadic practice, infection of joint arthroplasty is diagnosed by clinical history, serial radiological exams, whole blood sedimentation and CRP levels, direct microscopic examination and culture of joint aspirate. These steps are often time and money consuming procedures. In this study, we aim to describe a conducive method for the diagnosis of infection. We assumed that immunologic response to infection in synovial fluid can be a more reliable tool for the diagnosis of infection.In our study we planned to evaluate levels of Leukocyte Elastase, Gelatinase B, IL-1 alpha and IL-1 beta in synovial fluid and compare these results with other conventional parameters as culture, direct microscopy and sedimentation , CRP levels. If we achiave compatible results, these parameters can be reproducible, feasible and effective method for the diagnosis of prosthetic joint infection. Determination of Specific Prameters in Aspiration Material for İdentification of Prosthetic Joint İnfection Aim: Prosthesis infection to define the specific parameters by reference in the joint fluid taken from the easy, practical, reproducible and effective method septic or aseptic loosening. Materials and Methods: In this study, between 01.07.2013-20.07.2014 Orthopedics and Traumatology, Hacettepe University Hospital and Çankaya Hospital patients with knee and hip prosthesis revision surgery were studied prospectively. Patient demographic information, initial operation and revision surgery that date, ESR, Serum CRP, White Blood Cell, Culture reproductive happened isolated microorganisms, joint from fluid CRP, joint from fluid-specific parameters in the ELISA were analyzed. Statistical analysis using SPSS v. 5.11 was used. Results: Of 32 patients with Revision prosthesis surgery were 38 joint fluid. 15 of 38 infected joint fluid, and 23 were taken from non-infected group. The mean age of patients was 63. Of joint fluid taken 11 (28.9%) were male and 27 were female patients were included. In the study of synovial fluid 26 (68.4%) of the knee joint, 12 (31.6) were obtained from the hip joint. Sedimentation preoperative blood of patients cared for by Mann-Whitney U test were statistically significant differences between the two groups (p = 0.018). Preoperative serum CRP in the blood between the two groups in terms of Mann-Whitney U test found no statistically significant difference (p = 0.0001). White Blood Cell viewed in terms of blood between the two groups with Mann-Whitney U test was not a statistically significant difference (p = 0.68). Viewed from joint fluid of the specific parameters (Leukocyte Elastase, Gelatinase B, IL-1 beta, IL-1 alpha) in the infected group were significantly higher compared to uninfected. Mann-Whitney U test between the two groups statistically significant difference was found. CRP in synovial fluid is accepted in the group infected and uninfected groups, while the standard deviation 0.6 ± 0.21 0.21 ± 0.22 as the mean and standard deviation were calculated. Mann-Whitney U test were statistically significant differences between the two groups (p = 0.0001). Conclusion: From joint fluid analyzed by Elisa specific parameters significantly higher in the infected group emergence can help in the differentiation of septic and aseptic loosening. New parameters for the diagnosis of septic loosening can be created.