Hedlundh Urban, Karlsson Johanna, Sernert Ninni, Haag Lars, Movin Tomas, Papadogiannakis Nikos, Kartus Jüri
Orthopaedic Department NU Hospital Group, Uddevalla, Sweden.
Department of Infectious Diseases NU Hospital Group, Trollhattan, Sweden.
Bone Jt Open. 2023 Aug 22;4(8):628-635. doi: 10.1302/2633-1462.48.BJO-2023-0074.R1.
A revision for periprosthetic joint infection (PJI) in total hip arthroplasty (THA) has a major effect on the patient's quality of life, including walking capacity. The objective of this case control study was to investigate the histological and ultrastructural changes to the gluteus medius tendon (GMED) in patients revised due to a PJI, and to compare it with revision THAs without infection performed using the same lateral approach.
A group of eight patients revised due to a PJI with a previous lateral approach was compared with a group of 21 revised THAs without infection, performed using the same approach. The primary variables of the study were the fibril diameter, as seen in transmission electron microscopy (TEM), and the total degeneration score (TDS), as seen under the light microscope. An analysis of bacteriology, classification of infection, and antibiotic treatment was also performed.
Biopsy samples from the GMED from infected patients revealed a larger fibril diameter than control patients, as seen in the TEM (p < 0.001). Uninfected patients were slightly older and had their revisions performed significantly later than the infected patients. Histologically, samples from infected patients revealed significantly more vascularity (p < 0.001), the presence of glycosaminoglycans (p < 0.001), and a higher TDS (p = 0.003) than the control patients. The majority of patients had staphylococcal infections of various species.
More histological degeneration in the GMED was found in patients undergoing THA revision surgery due to PJI than in patients undergoing THA revision surgery due to other reasons.
全髋关节置换术（THA）中假体周围关节感染（PJI）的翻修对患者的生活质量有重大影响，包括步行能力。本病例对照研究的目的是调查因PJI进行翻修的患者臀中肌腱（GMED）的组织学和超微结构变化，并将其与采用相同外侧入路进行的无感染THA翻修术进行比较。
将一组因PJI且先前采用外侧入路进行翻修的8例患者与一组采用相同入路进行的21例无感染的THA翻修患者进行比较。研究的主要变量是透射电子显微镜（TEM）下观察到的原纤维直径和光学显微镜下观察到的总退变评分（TDS）。还进行了细菌学分析、感染分类和抗生素治疗。
TEM显示，感染患者GMED的活检样本显示原纤维直径大于对照患者（p < 0.001）。未感染患者年龄稍大，翻修手术时间明显晚于感染患者。组织学上，感染患者的样本显示血管明显增多（p < 0.001）、存在糖胺聚糖（p < 0.001），且TDS高于对照患者（p = 0.003）。大多数患者感染了各种葡萄球菌。
因PJI接受THA翻修手术的患者GMED的组织学退变比因其他原因接受THA翻修手术的患者更多。
