Üçüncü Basamak Merkeze Sevk Edilen Ağrılı Artroplasti Hastalarında Periprostetik Eklem Enfeksiyonu Tanı Süreci: Ortopedi ve Patoloji Perspektifi

Abstract

Bu çalışmanın amacı, üçüncü basamak merkeze sevk edilen ağrılı artroplasti hastalarında periprostetik eklem enfeksiyonu (PEE) tanı sürecini incelemektir. Ocak 2021-Ocak 2024 tarihleri arasında ağrılı kalça ve diz artroplastisi nedeniyle sevk edilen 85 hasta retrospektif olarak değerlendirildi. Hastaların yaş ortancası 67 yıl olup, %58.8'ine total diz artroplastisi uygulanmıştı. Patolojik değerlendirmede, olguların %52.9'u non-enfeksiyöz, %29.4'ü enfeksiyöz ve %17.7'si belirsiz olarak raporlandı. Enfeksiyöz patoloji varlığı PEE tanısıyla güçlü ilişki gösterirken (OR:4.92, p=0.001), non-enfeksiyöz patoloji varlığı negatif ilişki gösterdi (OR:0.31, p=0.026). Nötrofil infiltrasyonu ve bakteriyel kolonizasyon, enfeksiyon tanısında bağımsız belirteçler olarak saptandı. Aseptik gevşeme olgularında fibrohistiyositik reaksiyon baskın bulgu olarak öne çıktı. Demografik faktörler kontrol edildikten sonra, patolojik değerlendirmenin tanısal katkısı istatistiksel olarak anlamlı bulundu. Sonuçlarımız, ağrılı artroplasti hastalarında patolojik incelemenin tanısal değerini ve multidisipliner yaklaşımın önemini vurgulamaktadır.

Keywords

• Periprostetik Eklem Enfeksiyonu
• Tanısal Süreç
• Patolojik Değerlendirme
• Artroplasti Başarısızlığı
• Multidisipliner Yaklaşım

Diagnostic Process of Periprosthetic Joint Infection in Painful Arthroplasty Patients Referred to a Tertiary Care Center: Orthopedics and Pathology Perspective

Abstract

This study was aimed at determining the method of diagnosis of periprosthetic infection in the patients with painful joint arthroplasty referred to a tertiary center. Between January 2021 and January 2024, 85 patients referred for painful hip and knee arthroplasty were retrospectively evaluated. The median age of the patients was 67 years and 58.8% underwent total knee arthroplasty. Pathologically, 52.9% of the cases were reported as non-infectious, 29.4% as infectious and 17.7% as indeterminate. The presence of infectious pathology was strongly associated with the diagnosis of PEE (OR: 4.92, p=0.001), while the presence of non-infectious pathology was negatively associated (OR: 0.31, p=0.026). Neutrophil infiltration and bacterial colonization were independent markers for the diagnosis of infection. Fibrohistiocytic reaction was the dominant finding in cases of aseptic loosening. After controlling for demographic factors, the diagnostic contribution of pathologic evaluation was statistically significant. Our findings underscore the need for pathological assessment and highlight the importance of a team approach with different specializations in managing arthroplasty who complain of pain.

Keywords

• Periprosthetic Joint Infection
• Diagnostic Process
• Pathological Assessment
• Arthroplasty Failure
• Multidisciplinary Approach

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