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Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties

OBJECTIVES: To study the morphological changes of the regenerating synovium in two-stage revision arthroplasty, which is the gold standard for treatment of periprosthetic joint infection. DESIGN: The authors analysed a series of synovial biopsies to examine morphological changes in healing periprost...

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Autores principales: Gontarewicz, Arthur, Niggemeyer, Oliver, Tharun, Lars, Grancicova, Livia, Rüther, Wolfgang, Zustin, Jozef
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Group 2012
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425892/
https://www.ncbi.nlm.nih.gov/pubmed/22893669
http://dx.doi.org/10.1136/bmjopen-2012-001467
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author Gontarewicz, Arthur
Niggemeyer, Oliver
Tharun, Lars
Grancicova, Livia
Rüther, Wolfgang
Zustin, Jozef
author_facet Gontarewicz, Arthur
Niggemeyer, Oliver
Tharun, Lars
Grancicova, Livia
Rüther, Wolfgang
Zustin, Jozef
author_sort Gontarewicz, Arthur
collection PubMed
description OBJECTIVES: To study the morphological changes of the regenerating synovium in two-stage revision arthroplasty, which is the gold standard for treatment of periprosthetic joint infection. DESIGN: The authors analysed a series of synovial biopsies to examine morphological changes in healing periprosthetic tissues damaged by previous surgery and infection. METHODS: Synovial tissues from 19 patients (10 knees and 9 hips) who underwent a two-stage exchange surgery for periprosthetic infection were reviewed and correlated with clinical and laboratory findings. SETTING: Retrospective morphological study. PARTICIPANTS: Archival tissues from 19 two-stage revision arthroplasties in adult patients. RESULTS: Healing synovial tissue obtained at the reimplantation surgery showed characteristic layering: superficial fibrin exudate, immature richly vascularised granulation tissue and deeper maturing granulation tissue and fibrosis. Although increased neutrophil counts were found in the majority of cases, 2 of 19 cases showed dense infiltrates indicative of persistent infection, which correlated with positive microbiology in one case. One of the cases failed due to acetabular loosening and two cases failed due to late superinfection. One case showed a dense infiltration of eosinophils suggestive of a hypersensitivity reaction, which was subsequently proven by cutaneous tests. Foci of extramedullary haematopoiesis were detected in two cases. CONCLUSIONS: We observed characteristic morphological changes in the healing synovial tissue during reimplantation surgery for periprosthetic infection in serologically and microbiologically sterile tissues. Substantial increased counts of synovial neutrophils (>200 cells/10 high-power fields) seem to be indicative of persistent infection of the joint; therefore, prolonged antibiotic therapy should be considered in positive cases.
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spelling pubmed-34258922012-08-30 Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties Gontarewicz, Arthur Niggemeyer, Oliver Tharun, Lars Grancicova, Livia Rüther, Wolfgang Zustin, Jozef BMJ Open Pathology OBJECTIVES: To study the morphological changes of the regenerating synovium in two-stage revision arthroplasty, which is the gold standard for treatment of periprosthetic joint infection. DESIGN: The authors analysed a series of synovial biopsies to examine morphological changes in healing periprosthetic tissues damaged by previous surgery and infection. METHODS: Synovial tissues from 19 patients (10 knees and 9 hips) who underwent a two-stage exchange surgery for periprosthetic infection were reviewed and correlated with clinical and laboratory findings. SETTING: Retrospective morphological study. PARTICIPANTS: Archival tissues from 19 two-stage revision arthroplasties in adult patients. RESULTS: Healing synovial tissue obtained at the reimplantation surgery showed characteristic layering: superficial fibrin exudate, immature richly vascularised granulation tissue and deeper maturing granulation tissue and fibrosis. Although increased neutrophil counts were found in the majority of cases, 2 of 19 cases showed dense infiltrates indicative of persistent infection, which correlated with positive microbiology in one case. One of the cases failed due to acetabular loosening and two cases failed due to late superinfection. One case showed a dense infiltration of eosinophils suggestive of a hypersensitivity reaction, which was subsequently proven by cutaneous tests. Foci of extramedullary haematopoiesis were detected in two cases. CONCLUSIONS: We observed characteristic morphological changes in the healing synovial tissue during reimplantation surgery for periprosthetic infection in serologically and microbiologically sterile tissues. Substantial increased counts of synovial neutrophils (>200 cells/10 high-power fields) seem to be indicative of persistent infection of the joint; therefore, prolonged antibiotic therapy should be considered in positive cases. BMJ Group 2012-08-14 /pmc/articles/PMC3425892/ /pubmed/22893669 http://dx.doi.org/10.1136/bmjopen-2012-001467 Text en © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/3.0/ and http://creativecommons.org/licenses/by-nc/3.0/legalcode
spellingShingle Pathology
Gontarewicz, Arthur
Niggemeyer, Oliver
Tharun, Lars
Grancicova, Livia
Rüther, Wolfgang
Zustin, Jozef
Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties
title Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties
title_full Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties
title_fullStr Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties
title_full_unstemmed Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties
title_short Morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties
title_sort morphological study of synovial changes in two-stage reconstructions of the infected hip and knee arthroplasties
topic Pathology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3425892/
https://www.ncbi.nlm.nih.gov/pubmed/22893669
http://dx.doi.org/10.1136/bmjopen-2012-001467
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