Relevance. Total arthroplasty of large joints in patients with RA in some cases lead to the development of infectious postoperative complications. Treatment of patients with systemic inflammatory pathology of the connective tissue - the process is long and has certain features. Among others, we were interested in the persistence of an autoimmune inflammatory process and associated pathologies, including osteopenia or osteoporosis. Therefore, research into the effects of microbial contamination on bone repair processes is relevant. Objective. To identify correlation relationships between bone regenerative potential and microbial factor in identical biopsies of surgical material from RA patients with primary total endoprosthesis (PTE) and to determine their effect on surgical results Materials and methods. The data of microbiological researches of operative material after 151 surgical interventions from 118 patients with RA about PTE of joints (337 samples), executed according to the operating methods, are analyzed. 280 bone marrow specimens were examined and 400 cultures of bone marrow stromal fibroblasts were grown from these patients. Results. Microorganisms in the culture from surgical material were isolated in 55.4% of RA patients with knee and hip joints PTE. The nature of the microflora was determined: these are staphylococci, streptococci, Corynebacterium spp., Anaerobic non-spore-forming, gram-negative microorganisms. There is a strong (almost functional) linear inverse correlation (coefficient r = ─ 0.98) between osteogenic activity of bone marrow stromal bone marrow cells and data from microbiological studies of surgical material in patients with RA. Contamination of bone spongiosis by microorganisms is likely to reduce the activity of colony-forming units of bone marrow fibroblasts by an average of 81.0% in the depression, by 53.0% in the femoral head and by 64.8% in the intervertebral area. Microbial contamination inhibits osteogenic potential by an average of 30.4%, or almost 2 times, revealing one of the mechanisms of occurrence of probable complications and directing measures for their prevention (changes in postoperative antibiotic therapy). Conclusion. The higher the contamination with microorganisms, the lower the osteogenic activity of bone marrow stromal cells of bones forming the knee and hip joints in RA patients.
The use of bone scaffolds in traumatology and orthopedics is an extremely important issue. The growing number of cases of significant bone defects, in particular after revision arthroplasty, combat trauma and due to the introduction of new methods of reconstructive surgery of bones and joints, requires more detailed studies of the using different osteoplastic materials. Materials and methods. As scaffolds used 4 types of materials that are most often used in the clinic for the correction of bone defects - ceramic hydroxylapatite, beta-tricalcium phosphate, allogeneic bone matrix treated with gamma irradiation, allogeneic bone matrix scaffold. The effect of matrices on the viability of normal human fibroblasts (M19 cell line) in cell culture in vitro was studied. The viability of cells after their co-cultivation with scaffolds was determined by colorimetric method by staining with crystal violet. To obtain an osteoinductive effect used platelet-rich plasma (PRP), standardized by the method of Araki with some modifications. The proliferative activity of fibroblasts was assessed by the level of expression of the proliferation marker Ki-67 by immunocytochemical analysis. Results. It was found that the least pronounced antiproliferative effect is shown by allogeneic bone matrix treated with gamma irradiation. Data on the complex effect of co-cultivation of fibroblasts with scaffolds in the presence of PRP on cell viability and proliferative activity were obtained. It was found that PRP improves the survival of fibroblasts by 15-30 % and increases their proliferative activity by 35-75 %. Delipidization of scaffold from allogeneic bone matrix, heat-treated by local bone bank technology, increased its biocompatibility with human fibroblasts. Conclusions. According to the results of a comparative analysis of the impact of different scaffolds on the viability of normal human fibroblasts, it was found that scaffolds from allogeneic bone matrix have the least pronounced antiproliferative effect. Platelet-rich plasma has been shown to improve fibroblast survival and increase their proliferative activity. Treatment with 70 % ethyl alcohol scaffold from allogeneic bone matrix, heat-treated by local bone bank technology, increased its biocompatibility with human fibroblasts.
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