Increased local bone turnover in patients with chronic periprosthetic joint infection.

IF 4.7 2区 医学 Q2 CELL & TISSUE ENGINEERING Bone & Joint Research Pub Date : 2023-10-10 DOI:10.1302/2046-3758.1210.BJR-2023-0071.R1
Nico Hinz, Sebastian Butscheidt, Nico M Jandl, Holger Rohde, Johannes Keller, Frank T Beil, Jan Hubert, Tim Rolvien
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Abstract

Aims: The management of periprosthetic joint infection (PJI) remains a major challenge in orthopaedic surgery. In this study, we aimed to characterize the local bone microstructure and metabolism in a clinical cohort of patients with chronic PJI.

Methods: Periprosthetic femoral trabecular bone specimens were obtained from patients suffering from chronic PJI of the hip and knee (n = 20). Microbiological analysis was performed on preoperative joint aspirates and tissue specimens obtained during revision surgery. Microstructural and cellular bone parameters were analyzed in bone specimens by histomorphometry on undecalcified sections complemented by tartrate-resistant acid phosphatase immunohistochemistry. Data were compared with control specimens obtained during primary arthroplasty (n = 20) and aseptic revision (n = 20).

Results: PJI specimens exhibited a higher bone volume, thickened trabeculae, and increased osteoid parameters compared to both control groups, suggesting an accelerated bone turnover with sclerotic microstructure. On the cellular level, osteoblast and osteoclast parameters were markedly increased in the PJI cohort. Furthermore, a positive association between serum (CRP) but not synovial (white blood cell (WBC) count) inflammatory markers and osteoclast indices could be detected. Comparison between different pathogens revealed increased osteoclastic bone resorption parameters without a concomitant increase in osteoblasts in bone specimens from patients with Staphylococcus aureus infection, compared to those with detection of Staphylococcus epidermidis and Cutibacterium spp.

Conclusion: This study provides insights into the local bone metabolism in chronic PJI, demonstrating osteosclerosis with high bone turnover. The fact that Staphylococcus aureus was associated with distinctly increased osteoclast indices strongly suggests early surgical treatment to prevent periprosthetic bone alterations.

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慢性假体周围关节感染患者局部骨转换增加。
目的:假体周围关节感染(PJI)的管理仍然是整形外科面临的主要挑战。在本研究中,我们旨在表征慢性PJI患者的临床队列中的局部骨微观结构和代谢。方法:从患有慢性PJI的髋关节和膝关节患者(n=20)中获得假体周围股骨小梁骨标本。对术前关节抽吸物和翻修手术中获得的组织标本进行微生物学分析。通过未钙化切片的组织形态计量学和抗酒石酸酸性磷酸酶免疫组织化学分析骨标本的微观结构和细胞骨参数。将数据与初次关节成形术(n=20)和无菌翻修术(n=20)期间获得的对照标本进行比较。结果:与两个对照组相比,PJI标本表现出更高的骨体积、增厚的小梁和增加的类骨参数,这表明骨更新加速,具有硬化的微观结构。在细胞水平上,PJI队列中的成骨细胞和破骨细胞参数显著增加。此外,可以检测到血清(CRP)而不是滑膜(白细胞(WBC)计数)炎症标志物与破骨细胞指数之间的正相关。不同病原体之间的比较显示,与检测到表皮葡萄球菌和角质杆菌的患者相比,金黄色葡萄球菌感染患者的骨标本中破骨细胞骨吸收参数增加,而成骨细胞却没有随之增加。结论:本研究为慢性PJI的局部骨代谢提供了见解,显示骨硬化症伴有高骨转换。金黄色葡萄球菌与破骨细胞指数明显增加有关,这一事实强烈建议早期手术治疗以防止假体周围骨改变。
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来源期刊
Bone & Joint Research
Bone & Joint Research CELL & TISSUE ENGINEERING-ORTHOPEDICS
CiteScore
7.40
自引率
23.90%
发文量
156
审稿时长
12 weeks
期刊介绍: The gold open access journal for the musculoskeletal sciences. Included in PubMed and available in PubMed Central.
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