Inflammatory response in 85 patients with loosened hip prostheses: a prospective study comparing inflammatory markers in patients with aseptic and septic prosthetic loosening.
BACKGROUND
The most common complications of prosthetic hip joints are aseptic mechanical failure and infection. Delayed low-grade infections are seen most often, and they are also most difficult to distinguish from aseptic mechanical failures.


METHODS
We conducted a prospective study to compare inflammatory markers in patients diagnosed with aseptic or septic prosthetic loosening. The diagnostic criteria were based on the decisions of experienced orthopedic surgeons and microbiological analysis of periprosthetic tissue samples taken perioperatively.


RESULTS
Coagulase-negative staphylococci were the commonest pathogens in the infected patients. Pre- or perioperative elevation of C-reactive protein and erythrocyte sedimentation rate were significantly greater in the infection group, as were white blood cell count and levels of cytokines in synovial fluid. The patterns of infiltration of inflammatory cells in periprosthetic tissue were also significantly different between the groups.


CONCLUSIONS
A combination of clinical judgment and multiple tissue samples constitutes a good platform for distinguishing between septic and aseptic loosening of prostheses. Moreover, the combined use of several laboratory and histopathological markers of inflammation, especially infiltration of polymorphonuclear cells, further helps the diagnosis.
Nilsdotter-Augustinsson
Asa
A
Division of Infectious Diseases, Linköping University, Linköping, Sweden. asa.nilsdotter@lio.se
Briheim
Gunnar
G
Herder
Anders
A
Ljunghusen
Olof
O
Wahlström
Ola
O
Ohman
Lena
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001424:Bacterial Infections / Q000175:diagnosis / Q000276:immunology / Q000382:microbiology; D015415:Biomarkers / Q000032:analysis; D016207:Cytokines / Q000032:analysis; D005260:Female; D006621:Hip Joint / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000175:diagnosis / Q000209:etiology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D011446:Prospective Studies; D011475:Prosthesis Failure; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000276:immunology / Q000382:microbiology; D012086:Reoperation
D015415:Biomarkers; D016207:Cytokines