Prevention of purulent complications in the surgical treatment of patients with osteoarthritis of the hip joint

G.V. Gayko, A.V. Kalashnikov, O.B. Lutko, A.N. Sulima, T.I. Osadchuk, V.B. Zayets, T.V. Nizalov, A.A. Galuzinskiy, R.A. Kozak, P.S. Chernyak

Abstract


Background. Osteoarthritis is one of the most common degenerative-dystrophic diseases of the joints, which affect 6.4 to 12 % of the population. Deforming osteoarthritis of the hip joint (coxarthrosis — CA) makes up more than 40 % of all forms of osteoarthritis. Among the risk factors, there are: significant injury, inflammation and dysplasia of bone and cartilage tissues; in 26 % of cases, the causes of the degenerative process are uncertain. CA can initiate a lot of factors. Among them, there are genetic ones, which nowadays are of particular importance, endogenous and exogenous. Among the factors, inflammation is of certain importance. The purpose of this study is to develop a method for the prevention of septic complications in the surgical treatment of patients depending on the course of osteoarthritis of the hip joint. Materials and methods. The basis for the development of methods for the prevention of septic complications in the surgical treatment of patients, depending on the course of osteoarthritis of the hip joint, was the analysis of literature sources and own comprehensive microbiological, cultural and serological studies of 50 patients with idiopathic CA. Results. In stage III CA, in the complex of preoperative preparation of patients, the blood test for C-reactive protein (CRP) was included; if necessary (increased titer of CRP), we performed the puncture of the hip joint with the determination of the pathogen and the sensitivity of antibiotics and administration of antibiotics with directed action. If CRP level is below and equal to the norm, antibiotics are prescribed empirically (cefazolin, or vancomycin + clindamycin). During surgical interventions (organ-sparing surgery at moderate and slow CA progression and the total endoprosthesis (TEP) of the hip joint in rapidly progressive CA), intraoperative sampling (joint capsule, bone tissue) is being conducted with the determination of the pathogen and the sensitivity of antibiotics and administration of antibiotics with directed action. In case of negative result of microbiological examination, it is recommended to prescribe antibiotics empirically (cefazolin, or vancomycin + clindamycin). The method of choice for stage IV CA is total hip arthroplasty. In the complex of preoperative preparation of patients, the blood test for C-reactive protein was added; if necessary (increased titer of CRP), we performed the puncture of the hip joint with the determination of the pathogen and the sensitivity of antibiotics and administration of antibiotics with directed action. If CRP levels are below and equal to the norm, the antibiotics are prescribed empirically (cefazolin, or vancomycin + clindamycin). It is recommended to refuse the use of plastic material of the femoral head at bone defects in patients with the rapidly progressive form of the coxarthrosis course. Our microbiological research has proved the high contamination of the tissues forming the hip joint in patients with rapidly progressive CA. Using bone tissue of own femoral head for bone grafting may lead further to the development of septic and aseptic instability of endoprosthesis components. Therefore, to perform bone grafting of acetabular roof and floor in rapidly progressive form of coxarthrosis, we recommend to use allo- and autobone from other sites (wing of the ilium, etc.). During the TEP, intraoperative sampling (joint capsule, bone tissue) is performed with the determination of the pathogen, the sensitivity of antibiotics and administration of antibiotics with directed action. In case of negative result of microbiological examination, it is recommended to use antibiotics empirically (cefazolin, or vancomycin + clindamycin). Postoperatively, in patients after TEP of the hip joint, it is recommended to study serum levels of C-reactive protein every 4 months during the year, if necessary (increased CRP titer), to perform the puncture of the hip joint with the determination of the pathogen and the sensitivity of antibiotics and administration of antibiotics with directed action. According to our own studies, the introduction of a method for the prevention of purulent complications in the surgical treatment of patients depending on the course of osteoarthritis of the hip joint allowed to reduce by 5 % the number of septic complications after total hip replacement. Conclusions. Our research has shown a high efficiency of the proposed method for the prevention of purulent complications in the surgical treatment of patients with coxarthrosis. Implementation of the developed technique will contribute to improving the effectiveness of the medical care provision for patients with osteoarthritis of the hip joint.

Keywords


coxarthrosis; surgical interventions; suppurative complications; prevention

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DOI: https://doi.org/10.22141/1608-1706.3.18.2017.105368

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