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Abstract
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.
Interpretation 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.
Contributions of authors
ÅN-A: study design, coordination of study, collection and analysis of data, putting data and references together, and writing of the manuscript; corresponding author. GB: study design, clinical aspects from the field of infectious diseases, and critical review of the manuscript. AH: histopathological study design, histopathological analysis and evaluation of specimens, and critical review. OL: expert in the field of cytokines, analysis of data, and critical review. OW: study design, clinical aspects from the field of orthopedic surgery, and critical review. LÖ: supervisor, initiation of the study, study design, and critical review.
