Protsiuk V. Bone allografting in revision hip arthroplasty after septic and aseptic instability of the endoprosthesis

The issue of bone transplantation, replacing defects of the osseous tissue while performing revision hip replacement is urgent and not completely solved. The presented study is directed to improvement of anatomical and functional results of treatment of patients with osseous tissue defects in the portion of the hip joint with revision endoprosthetics due to improvement of differential diagnostics between septic and aseptic instability of the hip implant components by means of the methods of polarizationfluorescence microscopy, the use of the two-stage surgical treatment of peri-grafting infection applying articulation spacers in case of septic instability and the use of allografts from the bone bank in order to fill in osseous tissue defects in case of aseptic instability during revision hip arthroplasty. For differential diagnostics of aseptic and septic instability of the hip joint allograft the following instrumental methods are developed and substantiated on the basis of polarizing, Muller-matrix and laser-induced auto-fluorescent microscopy. By means of statistical and information analysis of the data of polarizing, Muller-matrix and laserinduced auto-fluorescent microscopy operation characteristics (sensitivity – Se, specificity – Sp, and accuracy – Ac) of the instrumental methods were determined. Сoordinate distribution mapping of the intensity of fluorescent non-protein fraction of SF films - sensitivity (Se) = 84%-93%; specificity (Sp) = 82%-91%; accuracy (Ac) = 83%-92%. The parameters of laser-polarimetric examination of the synovial fluid and the results of bacteriological examination of smears taken during revision hip arthroplasty coincided in 92,4% of cases, which was confirmed by remote results of clinical, laboratory and radiological observation of patients. The results of treatment of patients with bone alloplasty after aseptic instability, evaluated after 12 months showed good (78.8%) and satisfactory (14.0%) results on the Harris Hip Score (their average score was 87,18 ± 6,44 point). The results of revision arthroplasty after septic instability, evaluated in 49 patients (94.2%) indicate the achievement of eradication of infection in 44 (84.6%) patients. Of the 26 patients who underwent bone grafting defects after septic instability, after 12 months, integration and rearrangement of allobone took place in 23 (88.5%); obtained good (65.5%) and satisfactory (23.0%) functional results. According to the Harris Hip Score, the average score was 84.26 ± 7.64 points. The average observation period 31.4 ± 14.2 months.