Bäcker Henrik C, Wu Chia H, Krüger David, Gwinner Clemens, Perka Carsten, Hardt Sebastian
Department of Orthopaedic Surgery and Traumatology, Charité Berlin, University Hospital, Charitéplatz 1, 10117 Berlin, Germany.
Department of Orthopedics & Sports Medicine, Baylor College of Medicine Medical Center, Houston, TX 77030, USA.
J Clin Med. 2020 Oct 18;9(10):3349. doi: 10.3390/jcm9103349.
The effect of different bearings on synovial white blood cell (WBC) count and polymorphonuclear percentage (PMN%) in aspirations remains unclear. Therefore, this study investigates the impact of aseptic Metal-on-Metal (MoM) bearing on synovial fluid.
We searched our arthroplasty registry for aseptic painful THAs with MoM bearings between 2011 and 2018. Then, a case-matched control group was selected with septic and aseptic Total Hip Arthroplasty (THA) with ceramic on a polyethylene (PE) bearing. The matching criteria consisted of gender, age +/-10 years, and time of aspiration (+/-2years). Periprosthetic Joint Infection (PJI) was defined according to the Infectious Diseases Society of America (IDSA), and Musculoskeletal Infection Society (MSIS) using bacterial cultures, sonication and histology.
In total, 19 patients who underwent hip aspiration with MoM bearing were identified. Five patients had to be excluded due to insufficient synovial fluid obtained ( = 2) or bacterial growth after sonication that was initially negative with the standard microbiological cultures ( = 3). As such, 14 were included. These patients were matched with 14 aseptic and 14 septic THAs with ceramic on a PE bearing, which constituted the control group. The mean serum chrome level was 20.0 ± 15.5 nmol/L and cobalt level 18.4 ± 22.1 nmol/L. The synovial WBC and PMN% varied significantly between MoM bearing group and the aseptic THA ceramic PE group (both < 0.001), as well as the septic THA group (WBC = 0.016, PMN% < 0.001). Furthermore, the septic THA group had significantly higher CRP values than the aseptic MoM group ( = 0.016).
MoM bearing shows significantly higher synovial WBC and PMN% when compared to aseptic THA with ceramic on PE bearing above the MSIS cut-off. This is an important consideration when diagnosing periprosthetic joint infection using the MSIS guidelines.
不同的关节假体对关节穿刺液中滑膜白细胞（WBC）计数及多形核白细胞百分比（PMN%）的影响尚不清楚。因此，本研究调查了无菌金属对金属（MoM）关节假体对滑液的影响。
我们在关节置换登记系统中搜索了2011年至2018年间使用MoM关节假体的无菌性疼痛全髋关节置换术（THA）病例。然后，选取一组病例匹配的对照组，包括使用陶瓷对聚乙烯（PE）关节假体的感染性和无菌性全髋关节置换术（THA）。匹配标准包括性别、年龄（±10岁）和穿刺时间（±2年）。根据美国传染病学会（IDSA）和肌肉骨骼感染学会（MSIS）的标准，采用细菌培养、超声处理和组织学方法定义假体周围关节感染（PJI）。
总共确定了19例接受MoM关节假体髋关节穿刺的患者。5例患者因获取的滑液不足（n = 2）或超声处理后细菌生长（最初标准微生物培养为阴性，n = 3）而被排除。因此，纳入了14例患者。这些患者与14例无菌性和14例感染性陶瓷对PE关节假体的THA患者进行匹配，组成对照组。血清铬平均水平为20.0±15.5 nmol/L，钴水平为18.4±22.1 nmol/L。MoM关节假体组与无菌性THA陶瓷PE组之间的滑膜WBC和PMN%差异显著（均P < 0.001），与感染性THA组相比也有差异（WBC，P = 0.016；PMN%，P < 0.001）。此外，感染性THA组的CRP值显著高于无菌性MoM组（P = 0.016）。
与使用陶瓷对PE关节假体的无菌性THA相比，当MoM关节假体高于MSIS临界值时，其滑膜WBC和PMN%显著更高。在使用MSIS指南诊断假体周围关节感染时，这是一个重要的考虑因素。
