Department of Orthopedic Surgery, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.
Institute of Medical Microbiology, Infection Control and Prevention, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany.
J Shoulder Elbow Surg. 2018 Oct;27(10):1837-1844. doi: 10.1016/j.jse.2018.06.037. Epub 2018 Aug 20.
The early diagnosis of suspected periprosthetic low-grade infections in shoulder arthroplasties is important for the outcome of the revision surgical procedures. The aim of this study was to investigate new biomarkers of infection in revision shoulder arthroplasties, taking into account the implant design, patient age, and comorbidities.
The study included 33 patients with shoulder arthroplasties undergoing revision surgical procedures. Microbiological diagnostic testing was performed in all cases. C-reactive protein serum levels and white blood cell counts were evaluated, and the periprosthetic tissue was stained immunohistologically for the terminal complement pathway components (C3, C5, and C9) and for CD68 and α-defensin.
Microbiological diagnostic testing detected a periprosthetic infection in 10 reverse shoulder arthroplasties and in 4 anatomic shoulder arthroplasties, while the remaining 19 shoulder arthroplasties were classified as aseptic. We observed more Staphylococcus epidermidis infections in reverse shoulder arthroplasties and more Staphylococcus aureus infections in anatomic shoulder arthroplasties. The revision rate correlated with pre-existing comorbidities and number of previous surgical procedures. The C-reactive protein values and the incidence of specific periprosthetic radiolucent lines were significantly increased in septic revision cases. We found increased staining for all tested complement factors (C3, C5, and C9) but not for α-defensin and CD68 in septic tissue. The most interesting finding was that C9 separated septic from aseptic tissue with a predictive specificity of 100% and a sensitivity of 88.89%.
We observed a strong correlation between C9 expressions in septic revision tissue. We propose that the terminal complement pathway, especially C9 deposition, may be a potential biomarker to identify septic complications using tissue biopsy specimens.
早期诊断肩关节炎假体周围低度感染对翻修手术的结果很重要。本研究旨在探讨新的感染生物标志物在肩关节炎翻修术中，考虑到植入物设计、患者年龄和合并症。
该研究纳入了 33 例接受肩关节炎翻修手术的患者。所有病例均进行了微生物学诊断检测。评估了 C-反应蛋白血清水平和白细胞计数，并对假体周围组织进行了末端补体途径成分（C3、C5 和 C9）和 CD68 和α-防御素的免疫组织化学染色。
微生物学诊断检测在 10 例反向肩关节炎和 4 例解剖肩关节炎中发现假体周围感染，而其余 19 例肩关节炎被归类为无菌。我们观察到反向肩关节炎中更多的表皮葡萄球菌感染和解剖肩关节炎中更多的金黄色葡萄球菌感染。翻修率与既往合并症和既往手术次数有关。在感染性翻修病例中，C-反应蛋白值和特定假体周围透光线的发生率显著增加。我们发现所有检测的补体因子（C3、C5 和 C9）在感染组织中的染色均增加，但α-防御素和 CD68 染色未增加。最有趣的发现是 C9 可以将感染与非感染组织区分开来，特异性为 100%，敏感性为 88.89%。
我们观察到感染性翻修组织中 C9 表达之间存在很强的相关性。我们提出末端补体途径，特别是 C9 沉积，可能是通过组织活检标本识别感染性并发症的潜在生物标志物。
