Johnson Andrea H, Brennan Jane C, Turcotte Justin J, King Paul J
Orthopedics, Anne Arundel Medical Center, Annapolis, USA.
Orthopedic Research, Anne Arundel Medical Center, Annapolis, USA.
Cureus. 2024 Oct 4;16(10):e70823. doi: 10.7759/cureus.70823. eCollection 2024 Oct.
Background Metal-on-metal (MoM) bearing surfaces have been implicated as a cause of increased complication rates in total hip arthroplasty (THA), with local and systemic reactions identified. These reactions may cause abnormal laboratory results in common tests that are used to diagnose periprosthetic joint infection (PJI). The purpose of this study was to evaluate the utility of common laboratory studies in the diagnosis of PJI in patients undergoing revision THA with MoM bearings. Methods A retrospective case series of 81 patients undergoing THA revision of MoM bearings from January 2010 to May 2023 at a single institution was performed. Patient data was extracted from the electronic medical record. All patients were evaluated using the 2018 International Consensus Meeting (ICM) definition of PJI. Descriptive statistics were calculated for the clinical characteristics of all patients. Univariate analyses were performed to compare patients who met the ICM criteria for infection with those deemed indeterminate. Results Fifty-one (63.0%) patients were deemed not infected according to ICM criteria, 19 (23.5%) were deemed indeterminate, and 11 (13.6%) were deemed infected. Clinically, four patients had two or more positive cultures and were formally treated for PJI; all patients were deemed inconclusive, and the remaining seven patients deemed infected were clinically treated as not infected, and all remained infection-free. There were significant differences between patients deemed inconclusive and those deemed infected in synovial WBC count (17,539 vs. 90,196 cells/μL, p = 0.049) and synovial polymorphonuclear (PMN) neutrophils (38 vs. 79%, p = 0.002). No other significant differences in laboratory values or outcomes were noted between groups. Conclusions Patients undergoing revision THA with MoM bearings may be more likely to present with a clinical picture that is concerning for infection and may benefit from a more aggressive preoperative workup. The synovial PMN neutrophil percentage may help differentiate between hips that are infected and those that are not.
背景 金属对金属（MoM）关节面被认为是全髋关节置换术（THA）并发症发生率增加的一个原因，已发现有局部和全身反应。这些反应可能导致用于诊断假体周围关节感染（PJI）的常见检查出现异常实验室结果。本研究的目的是评估常见实验室检查在诊断接受MoM关节面翻修THA患者的PJI中的效用。方法 对2010年1月至2023年5月在单一机构接受MoM关节面THA翻修的81例患者进行回顾性病例系列研究。从电子病历中提取患者数据。所有患者均根据2018年国际共识会议（ICM）对PJI的定义进行评估。计算所有患者临床特征的描述性统计数据。进行单因素分析以比较符合ICM感染标准的患者与被认为不确定的患者。结果 根据ICM标准，51例（63.0%）患者被认为未感染，19例（23.5%）被认为不确定，11例（13.6%）被认为感染。临床上，4例患者有两种或更多阳性培养物并接受了PJI的正规治疗；所有患者均被认为结果不明确，其余7例被认为感染的患者在临床上被视为未感染，且均未再发生感染。在滑膜白细胞计数（17,539对90,196个细胞/μL，p = 0.049）和滑膜多形核（PMN）中性粒细胞（3对79%，p = 0.002）方面，结果不明确的患者与被认为感染的患者之间存在显著差异。各组之间在实验室值或结果方面未发现其他显著差异。结论 接受MoM关节面翻修THA的患者可能更有可能出现令人担忧的感染临床表现，可能受益于更积极的术前检查。滑膜PMN中性粒细胞百分比可能有助于区分感染的髋关节和未感染的髋关节。
