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Yeudakimau D.V., Kubrakov K.M., Balaboshka K.B., Semenov V.M.
Diagnosing of infectious complications after arthroplasty
Vitebsk State Order of Peoples’ Friendship Medical University, Vitebsk, Republic of Belarus

Vestnik VGMU. 2018;17(3):16-24.

Periprosthetic purulent infection is one of the most challenging complications after arthroplasty of the large joints. The diagnosis of it still seems to be a serious problem in the clinical practice of orthopedists. In a number of cases, constant pain in the area of the prosthetic joint is a single subjective symptom. To date, the available diagnostic methods are not highly specific and sensitive. The reliable tests include only intraoperative sampling of soft tissues for the histological and bacteriological analyses. However, the treatment results can be significantly improved in case of the early diagnosis of purulent complications development after the large joints arthroplasty. The article presents the review of a number of widely used methods for diagnosing purulent complications after joint arthroplasty with a description of their clinical potentialities.
Key words: arthroplasty, periprosthetic infection, knee joint, diagnosis, D-lactate.


1. Makushin VD, Chegurov OK. Social adaptation and quality of life of elderly and senile patients in the treatment of gonarthrosis. Genii ortopedii. 2005;(1): 22-5. (In Russ.)
2. Felson DT, Lawrence RC, Dieppe PA, Hirsch R, Helmick CG, Jordan JM, et al. Osteoarthritis: new insights. Part 1: the disease and its risk factors. Ann Intern Med. 2000 Oct;133(8):635-46.
3. Felson DT, Zhang Y. An update on the epidemiology of knee and hip osteoarthritis with a view to prevention. Arthritis Rheum. 1998 Aug;41(8):1343-55. doi:<1343::AID-ART3>3.0.CO;2-9
4. Bliddal H, Christensen R. The treatment and prevention of knee osteoarthritis: a tool for clinical decision-making. Expert Opin Pharmacother. 2009 Aug;10(11):1793-804. doi:
5. Pokrovskiy VI, red. Small medical encyclopedia: v 6 t. Moscow, RF: Meditsina, 1996. T 4: Nephrotomy-Renal failure. 576 р. (In Russ.)
6. Dieppe PA. Lohmander LS. Pathogenesis and management of pain in osteoarthritis. Lancet. 2005 Mar;365(9463):965-73. doi:
7. Esser S, Bailey A. Effects of exercise and physical activity on knee OA. Curr Pain Headache Rep. 2011 Dec;15(6):423-30. doi:
8. Fernandes JC, Martel-Pelletier J, Pelletier JP. The role of cytokines in osteoarthritis pathophysiology. Biorheology. 2002;39(1-2):237-46.
9. Ogdie A, Li J, Dai L, Paessler ME, Yu X, Diaz-Torne C, et al. Identification of broadly discriminatory tissue biomarkers of synovitis with binary and multicategory receiver operating characteristic analysis. Biomarkers. 2010 Mar;15(2):183-90. doi:
10. Scanzello CR, Umoh E, Pessler F, Diaz-Torne C, Miles T, Dicarlo E, et al. Local cytokine profiles in knee osteoarthritis: elevated synovial fluid interleukin-15 differentiates early from end-stage disease. Osteoarthritis Cartilage. 2009 Aug;17(8):1040-8. doi:
11. Benito MJ, Veale DJ, FitzGerald O, van den Berg WB, Bresnihan B. Synovial tissue inflammation in early and late osteoarthritis. Ann Rheum Dis. 2005 Sep;64(9):1263-7. doi:
12. Houli J, Roimicher S, Paciornik I, de Paola D. Synovial tissue in osteoarthritis of the knee. Acta Rheumatol Scand. 1959;5:122-35.
13. Pawłowska J, Mikosik A, Soroczynska-Cybula M, Jóźwik A, Łuczkiewicz P, Mazurkiewicz S, et al. Different distribution of CD4 and CD8 T cells in synovial membrane and peripheral blood of rheumatoid arthritis and osteoarthritis patients. Folia Histochem Cytobiol. 2009;47(4):627-32. doi:
14. Ishii H, Tanaka H, Katoh K, Nakamura H, Nagashima M, Yoshino S. Characterization of infiltrating T cells and Th1/ Th2-type cytokines in the synovium of patients with osteoarthritis. Osteoarthritis Cartilage. 2002 Apr;10(4):277-81.
15. Rollín R, Marco F, Jover JA, García-Asenjo JA, Rodríguez L, López-Durán L, et al. Early lymphocyte activation in the synovial microenvironment in patients with osteoarthritis: comparison with rheumatoid arthritis patients and healthy controls. Rheumatol Int. 2008 Jun;28(8):757-64. doi:
16. Pessler F, Chen LX, Dai L, Gomez-Vaquero C, Diaz-Torne C, Paessler ME, et al. A histomorphometric analysis of synovial biopsies from individuals with Gulf War Veterans’ illness and joint pain compared to normal and osteoarthritis synovium. Clin Rheumatol. 2008 Sep;27(9):1127-34. doi:
17. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030. J Bone Joint Surg Am. 2007 Apr;89(4):780-5. doi:
18. Havelin LI, Fenstad AM, Salomonsson R, Mehnert F, Furnes O, Overgaard S, et al. The Nordic Arthroplasty Register Association: a unique collaboration between 3 national hip arthroplasty registries with 280,201 THRs. Acta Orthop. 2009 Aug;80(4):393-401. doi:
19. Robertsson O, Bizjajeva S, Fenstad AM, Furnes O, Lidgren L, Mehnert F, et al. Knee arthroplasty in Denmark, Norway and Sweden. A pilot study from the Nordic Arthroplasty Register Association. Acta Orthop. 2010 Feb;81(1):82-9. doi:
20. Beletskiy AV. Belarusian day in traumatology and orthopedics: [on the development of orthopedic and traumatology service in the Republic of Belarus]. Medvestnik. 2014; 30 okt. (In Russ.)
21. Tande AJ, Patel R. Prosthetic Joint Infection. Clin Microbiol Rev. 2014 Apr;27(2):302-45. doi:
22. Girkalo MV, Markov DA, Klochkov MA, Shpinyak SP. Surgical treatment of purulent complications in knee replacement. V: Problemy diagnostiki i lechenie povrezhdenii i zabolevanii tazobedrennogo sustava: tez Vseros nauch-prakt konf s mezhdunar uchastiem, Kazan', 5-7 sent 2013 g. Kazan, RF; 2013. Р. 26-7. (In Russ.)
23. Kil'metov TA, Tsibul'kina VN, Akhtyamov IF, Gatina EB, Eremin IK, Aliev EI. Immunological changes in infectious complications after total joint replacement. V: Problemy diagnostiki i lechenie povrezhdenii i zabolevanii tazobedrennogo sustava: tez Vseros nauch-prakt konf s mezhdunar uchastiem, 5-7 sent 2013 g. Kazan, RF; 2013. Р. 57-9. (In Russ.)
24. Kurtz SM, Lau E, Watson H, Schmier JK, Parvizi J. Economic burden of periprosthetic joint infection in the United States. J Arthroplasty. 2012 Sep;27(8 Suppl):61-5.e1. doi:
25. Southwood RT, Rice JL, McDonald PJ, Hakendorf PH, Rozenbilds MA. Infection in experimental hip arthroplasties. J Bone Joint Surg Br. 1985 Mar;67(2):229-31.
26. Uçkay I, Lübbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T, et al. Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect. 2009 Nov;59(5):337-45. doi:
27. Schäfer P, Fink B, Sandow D, Margull A, Berger I, Frommelt L. Prolonged bacterial culture to identify late periprosthetic joint infection: a promising strategy. Clin Infect Dis. 2008 Dec;47(11):1403-9. doi:
28. Bengtson S, Knutson K. The infected knee arthroplasty. A 6-year follow-up of 357 cases. Acta Orthop Scand. 1991 Aug;62(4):301-11.
29. Berbari E, Mabry T, Tsaras G, Spangehl M, Erwin PJ, Murad MH, et al. Inflammatory blood laboratory levels as markers of prosthetic joint infection: a systematic review and meta-analysis. J Bone Joint Surg Am. 2010 Sep;92(11):2102-9. doi:
30. Worthington T, Dunlop D, Casey A, Lambert R, Luscombe J, Elliott T. Serum procalcitonin, interleukin-6, soluble intercellular adhesin molecule-1 and IgG to short-chain exocellular lipoteichoic acid as predictors of infection in total joint prosthesis revision. Br J Biomed Sci. 2010;67(2):71-6.
31. Gollwitzer H, Dombrowski Y, Prodinger PM, Peric M, Summer B, Hapfelmeier A, et al. Antimicrobial peptides and proinflammatory cytokines in periprosthetic joint infection. J Bone Joint Surg Am. 2013 Apr;95(7):644-51. doi:
32. Bottner F, Wegner A, Winkelmann W, Becker K, Erren M, Götze C. Interleukin-6, procalcitonin and TNF-alpha: markers of peri-prosthetic infection following total joint replacement. J Bone Joint Surg Br. 2007 Jan;89(1):94-9. doi:
33. Cyteval C, Hamm V, Sarrabère MP, Lopez FM, Maury P, Taourel P. Painful infection at the site of hip prosthesis: CT imaging. Radiology. 2002 Aug;224(2):477-83. doi:
34. Rosenthall L, Lepanto L, Raymond F. Radiophosphate uptake in asymptomatic knee arthroplasty. J Nucl Med. 1987 Oct;28(10):1546-9.
35. Magnuson JE, Brown ML, Hauser MF, Berquist TH, Fitzgerald RH Jr, Klee GG. In-111-labeled leukocyte scintigraphy in suspected orthopedic prosthesis infection: comparison with other imaging modalities. Radiology. 1988 Jul;168(1):235-9. doi:
36. Nagoya S, Kaya M, Sasaki M, Tateda K, Yamashita T. Diagnosis of periprosthetic infection at the hip using triple-phase bone scintigraphy. J Bone Joint Surg Br. 2008 Feb;90(2):140-4. doi:
37. Love C, Marwin SE, Tomas MB, Krauss ES, Tronco GG, Bhargava KK, et al. Diagnosing infection in the failed joint replacement: a comparison of coincidence detection 18F-FDG and 111In-labeled leukocyte/99mTc-sulfur colloid marrow imaging. J Nucl Med. 2004 Nov;45(11):1864-71.
38. Belov BS, Makarov SA, Byalik EI. Prosthetic joint infection: current status of the problem. Sovremen Revmatologiia. 2013;7(4):4-9. (In Russ.)
39. Dolgov VV, Shabalova IP, Mironova II, Dzhangirova TV, Korotaev AL. Evaporative fluids. Laboratory research. Moscow, RF: Triada; 2006. 161 р. (In Russ.)
40. Ghanem E, Parvizi J, Burnett RS, Sharkey PF, Keshavarzi N, Aggarwal A, et al. Cell count and differential of aspirated fluid in the diagnosis of infection at the site of total knee arthroplasty. J Bone Joint Surg Am. 2008 Aug;90(8):1637-43. doi:
41. Trampuz A, Hanssen AD, Osmon DR, Mandrekar J, Steckelberg JM, Patel R. Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infection. Am J Med. 2004 Oct 15;117(8):556-62. doi:
42. Zmistowski B, Restrepo C, Huang R, Hozack WJ, Parvizi J. Periprosthetic joint infection diagnosis: a complete understanding of white blood cell count and differential. J Arthroplasty. 2012 Oct;27(9):1589-93. doi:
43. Parvizi J, Jacovides C, Antoci V, Ghanem E. Diagnosis of periprosthetic joint infection: the utility of a simple yet unappreciated enzyme. J Bone Joint Surg Am. 2011 Dec;93(24):2242-8. doi:
44. Wetters NG, Berend KR, Lombardi AV, Morris MJ, Tucker TL, Della Valle CJ. Leukocyte esterase reagent strips for the rapid diagnosis of periprosthetic joint infection. J Arthroplasty. 2012 Sep;27(8 Suppl):8-11. doi:
45. Ali F, Wilkinson JM, Cooper JR, Kerry RM, Hamer AJ, Norman P, et al. Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty. J Arthroplasty. 2006 Feb;21(2):221-6. doi:
46. Roberts P, Walters AJ, McMinn DJ. Diagnosing infection in hip replacements. The use of fine-needle aspiration and radiometric culture. J Bone Joint Surg Br. 1992 Mar;74(2):265-9.
47. Kubrakov KM, Semenov VM, Zen'kova SK. Diagnostic value of D-lactate in cerebrospinal fluid for diagnosis of purulent meningoencephalitis. Klin Infektologiia Parazitologiia. 2017;(1):22-30. (In Russ.)
48. Chen Z, Wang Y, Zeng A, Chen L, Wu R, Chen B, et al. The clinical diagnostic significance of cerebrospinal fluid D-lactate for bacterial meningitis. Clin Chim Acta. 2012 Oct;413(19-20):1512-5. doi:
49. Karbysheva SB, Grigoricheva LG, Zhil'tsov I, Semenov VM, Zolovkina AG, Veremey IS, i dr. D-lactate-a marker of bacterial inflammation of the native and prosthetic joints. Travmatologiia Ortopediia Rossii. 2017;23(2):6-14. (In Russ.)

Information about authors:
Yeudakimau D.V. – lecturer of the Chair of Traumatology, Orthopedics & Military Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Kubrakov K.M. – Candidate of Medical Sciences, associate professor of the Chair of Neurology & Neurosurgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Balaboshka K.B. – Candidate of Medical Sciences, associate professor, head of the Chair of Traumatology, Orthopedics & Military Surgery, Vitebsk State Order of Peoples’ Friendship Medical University;
Semenov V.M. – Doctor of Medical Sciences, professor, head of the Chair of Infectious Diseases with the course of the Faculty for Advanced Training & Retraining, Vitebsk State Order of Peoples’ Friendship Medical University.

Correspondence address: Republic of Belarus, 210023, Vitebsk, 27 Frunze ave., Vitebsk State Order of Peoples’ Friendship Medical University, Chair of Traumatology, Orthopedics & Military Surgery. E-mail: Этот адрес электронной почты защищён от спам-ботов. У вас должен быть включен JavaScript для просмотра. – Dzmitry V. Yeudakimau.

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