Peculiarities of immune response in patients with early infectious complications after knee and hip joint arthroplasty
The aim of the work was to reveal the parameters of immune response for prognosis of the early postoperative complications after knee and hip joint arthroplasty. Methods: there
were 47 patients, aged 35–80 years with primary hip and knee arthritis after arthroplasty. 32 patients (1 group) had a favorable early postoperative course, 15 patients (2 group) had infectious complications. Level of autoimmune lymphocytotoxic (ALA) and granulocytotoxic antibodies (AGA), neutrophiles and lymphocytes, circulating immune complexes (CIC) were studied in synovial fluid and blood. The cell immune response was assessed in the test of leukocyte migration inhibition (LMIT) towards antigens of synovial membrane, bone and cartilage tissue, as well as towards bacterial antigens of Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus pyogenes, Clebsiella pneumoniae and Candida Lusitaniae. Results: the patients of the 2 group demonstrated lower level of neutrophiles
in peripheral blood and higher one — in synovial fluid as compared to the patients of the 1 group. Neutrophile/lymphocyte ratio comprised 1.5 in the 2 group and 2.0 in the 1 group. Patients with infectious complications were characterized by the presence of ALA and higher level of AGA in the serum. ALA/AGA ratio in the 2 group comprised 1.5, in the 1 group — 2.0. The patients with infectious complications demonstrated higher level of ALA in synovial fluid (21.5 ± 0.92 %) and autoimmune origin of granulocytotoxic antibodies. Significant leukocyte migration towards synovial membrane and cartilage in LMIT was revealed
in the patients of the 2 group before the surgery, that was associated with leukocyte migration enhancement towards those bacterial antigens, that were bacteriologically found in synovial fluid. Conclusions: lukocyte migration enhancement towards antigens of synovial membrane and joint tissue, as well as towards pathogenic bacteria along with the presence of ALA and increase of AGA in the serum and synovial fluid are considered as parameters of the complicated course of postoperative period after arthroplasty with a necessity of medical correction.
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