Diagnostic value of serum Interleukin-6 combined with synovial IL-6 and C-reactive protein for prosthesis joint infection in patients after joint arthroplasty

Objective:To explore the diagnostic value of serum Interleukin-6(IL-6)combined with synovial IL-6 and C-reactive protein for prosthesis joint infection(PJI)in patients after joint arthroplasty.Methods:A total of 253 patients undergoing revision surgery after the first total hip and total knee arthroplasty in the Second Affiliated Hospital of Hainan Medical College from January 2018 to April 2020 were recruited as the study object.The patients were divided into the PJI group(n=85)and non-PJI group(n=168)according to whether there was PJI,and the baseline characteristics and the laboratory indexe were collected and compared between the two groups.the factors associated with PJI in patients after joint arthroplasty were analyzed by multivariate logistic regression model.And the diagnostic value of each marker for PJI in patients after joint arthroplasty was evaluated by Receiver Operating Characteristic(ROC)curve.Results:The incidence of PJI in this study was 33.6%.Compared with the non-PJI group,the patients in the PJI group had more diabetes mellitus and shorter prosthesis duration(P<0.05).The levels of serum C-reactive protein(CRP),serum interleukin-6(IL-6),synovial IL-6,synovial CRP,synovial leukocyte,synovial neutrophil and ESR in the PJI group were higher than those in non-PJI group,and the level of synovial lymphocyte was lower,with statistically significant differences(P<0.05).Multivariate logistic regression analysis showed that diabetes mellitus(OR=1.706,95%CI:1.02~2.376,P=0.037),prosthesis duration(OR=0.781,95%CI:0.690~0.884,P<0.001),serum IL-6(OR=1.008,95%CI:1.004~1.012,P=0.046),synovial IL-6(OR=1.004,95%CI:1.002~1.006,P=0.011)and synovial CRP(OR=1.481,95%CI:1.010~2.170,P=0.044)were independently related to PJI in patients after joint arthroplasty.ROC curve analysis showed that the area under ROC curve(AUC)of serum IL-6 combined with synovial IL-6 and CRP for diagnose PJI in patients after joint arthroplasty was significantly greater than each marker(0.941 vs 0.760,Z=6.333,P<0.001;0.941 vs 0.743,Z=7.189,P<0.001;0.941 vs 0.785,Z=4.999,P=0.006).Conclusion:Serum IL-6,synovial IL-6 and CRP were independently related to PJI in patients after joint arthroplasty.They all had some diagnostic value,and serum IL-6 combined with synovial IL-6 and CRP had higher capability to diagnose PJI in patients after joint arthroplasty than each marker alone.

Study on Biotribological Behavior of the Combined Joint of CoCrMo and UHMWPE/BHA Composite in a Hip Joint Simulator

UHMWPE composites reinforced with Bovine Bone Hydroxyapatite(BHA)in different contents were prepared by heat pressing formation method.A hip joint wear simulator was used to investigate the biotribological behavior of UHMWPE/BHA composite acetabular cups against CoCrMo alloy femoral heads in bovine synovia lubrication at 37±1 ℃.It was found that the addition of BHA powder to UHMWPE can improve the hardness and creep modulus of UHMWPE/BHA composites,and decrease their wear rates under bovine synovia lubrication.When the content of BHA filler particles was up to 30 wt%, UHMWPE/BHA composites demonstrated the well design performances of the surface and biotribological properties.Fatigue, ploughing and slight adhesive wear were the main wear mechanisms for UHMWPE and its composites.In addition,the sizes of wear particles became larger with an increase in BHA powder addition.These results suggest that BHA filler is a desirable component to increase the wear resistance of UHMWPE/BHA composites for biomedical applications.

氨甲环酸在人工关节外科领域的应用

关节外科手术失血量一般较大,初次人工全膝关节置换术(total knee arthroplasty,TKA)后的失血量可达到1000~1790 ml[1],初次人工全髋关节置换术(total hip arthroplasty,THA)失血量更大,平均可达到1944ml[2],脊柱外科手术亦有大量出血的风险。随着外科手术技术的提高,例如小切口全髋关节置换术(minimal incision THA,MIS-THA)等骨科微创手术,以及自体血回输、术后引流血回输、急性等溶性血液稀释。