Histopathology in Periprosthetic Joint Infection: When Will the Morphomolecular Diagnosis Be a Reality?

Bori, Guillem; McNally, Martin; Athanasou, Nicholas A.

doi:10.1155/2018/1412701

Cited by 24 publications

(29 citation statements)

References 60 publications

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“…For example, after fourteen days following implantation, the numbers of lymphocytes and macrophages counted in averages/per section infiltrated at the site of implanted materials decreases, with more of the mononuclear cells invading the PLLA membrane observed when compared to that of PLLA/C 3 S implant. However, because the lymphocytes did not distribute homogenously, it might not be representative to present the average number of lymphocytes per section, and the quantitative histomorphometrical analysis of our samples is required for clinical practice in future research with the proper sampling method provided [42].…”

Section: Qualitative Analysis Of In Vivo Animal Testsmentioning

confidence: 99%

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

et al. 2019

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Kyphoplasty is an important treatment for stabilizing spine fractures due to osteoporosis. However, leakage of polymethyl-methacrylate (PMMA) bone cement during this procedure into the spinal canal has been reported to cause many adverse effects. In this study, we prepared an implantable membrane to serve as a barrier that avoids PMMA cement leakage during kyphoplasty procedures through a hybrid composite made of poly-l-lactic acid (PLLA) and tricalcium silicate (C 3 S), with the addition of C 3 S into PLLA matrix, showing enhanced mechanical and anti-degradation properties while keeping good cytocompatibility when compared to PLLA alone and most importantly, when this material design was applied under standardized PMMA cement injection conditions, no posterior wall leakage was observed after the kyphoplasty procedure in pig lumbar vertebral bone models. Testing results assess its effectiveness for clinical practice.2 of 17 the created cavity after balloon inflation during the kyphoplasty procedure [10]. Following which the balloon is re-inserted and inflated, creating a cement shell or a cement membrane around the inner walls of the created cavity, and another batch of cement was mixed and injected into the remaining cavity thereafter with limited cement leakage possibility from initial cement setting. Although this double cement application with PMMA as the cement anti-leakage shell or membrane has demonstrated its efficacy in clinical trial during the kyphoplasty procedure [11], the long term complications might be devastating due to PMMA presence on the bone cement surface [9], which makes the development of a new material design for anti-leakage membrane necessary. For example, Tetsushi Taguchi et al. had fabricated the reactive poly(vinyl alcohol) (PVA) membrane for the prevention of bone cement leakage with good potential for implantable balloon kyphoplasty, but further investigations on its clinical efficiency are still in progress [12].On the other hand, polymeric membranes fabricated from a single material more often have limited biological performance compared to the use of hybrid biomaterials composed of biodegradable synthetic polymers and inorganic materials, with the hybrid biomaterials fitting better to bone tissue engineering applications due to their similar compositions to natural bones [13,14]. For example, biodegradable polymers such as poly(L-lactic acid) (PLLA) (L-lactic acid isomer of polylactic acid (PLA), an aliphatic thermoplastic polyester obtained by polymerizing lactide monomers) have been used for scaffold design doped with dicalcium silicate (C 2 S) nanoparticles as an ideal candidate for novel bone graft substitutes with enhanced mechanical and biodegradable properties, and biointeractive nature [15,16]. Scaffolds fabricated from (PLLA)/dicalcium phosphate dihydrate (DCPD) composite by indirect casting had also shown to effectively improve the mechanical strength and biocompatibility for the repair of bone defects when compared to the scaffold from neat PLLA [17]. From which the h...

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Section: Qualitative Analysis Of In Vivo Animal Testsmentioning

confidence: 99%

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

et al. 2019

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“…However, some authors suggested that the histopathological threshold is too high for the diagnosis of all arthroplasty infections 9 . Indeed, certain microorganisms, especially coagulase-negative staphylococci and Cutibacterium acnes ( C. acnes ), could cause a prosthetic infection with a PMN infiltration rate <5 PMNs per field 6 . Additionally, Mirra's criterion has low sensitivity to predict the presence of microorganisms in samples from suspected aseptic prosthetic loosening 10 .…”

Section: Introductionmentioning

confidence: 99%

Plasma Cell Infiltration on Histopathological Samples of Chronic Bone and Joint Infections due to Cutibacterium acnes: A series of 21 Cases

Trécourt

Brevet

Champagnac

et al. 2020

J. Bone Joint Infect.

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Abstract. Introduction: Histopathological definition of bone and joint infection (BJI) is based on Mirra's criterion (≥ 5 polymorphonuclears (PMNs) per field in 5 high power fields (HPFs)). However, this definition does not seem appropriate for chronic BJIs caused by slow-growing germs such as Cutibacterium acnes (C. acnes). The aim of this study was to confirm that Mirra's criterion is not adequate for diagnosis of BJIs due to C. acnes. The second objective was to determine if plasma cell infiltration could be useful for the diagnosis of chronic BJIs due to C. acnes.Methods: We retrospectively selected 25 consecutive patients from 2009 to 2013 with chronic BJIs due to C. acnes. Histological analysis was performed on the 21 cases with at least two C. acnes positive cultures. In addition of Mirra's criterion, the number of plasma cells (≥5 plasma cells/5 HPFs, defined as “CRIOAc Lyon's criterion”) was implemented in the histopathological analysis. Patients were defined as infected, if at least one of the two criteria were present.Results: According to Mirra's and CRIOAc Lyon's criteria, positive histopathology was observed in 12 (57.1%) and 15 (71.4%) cases respectively. Considering the 9 cases with negative Mirra's criterion, high plasma cell infiltration (≥5 plasma cells per field/5 HPFs) was observed in 5 cases (55.6%), and low plasma cells infiltration (2-5 plasma cells per field/5 HPFs) was observed in 4 other cases (44.4%).Conclusions: Adding CRIOAc Lyon's criterion to Mirra's criterion might restore some histopathological diagnosis of chronic BJIs due to C. acnes when a chronic BJI is clinically suspected.

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“…In a previous study on hip implant failure (which pre-dated the formulation of MSIS criteria for the diagnosis of PJI), we found that histology correlated more closely than microbiology with regard to the final clinical diagnosis of SIF [ 10 ]. Although the value of histology in the assessment of arthroplasties has been shown in recent studies [ 3 , 10 – 14 ], there is controversy regarding its relative importance in establishing this diagnosis of PJI, and, with regard to knee arthroplasties, histological parameters for this diagnosis have not formally been defined. In this study, we have compared histological and microbiological findings in 138 cases of knee arthroplasty failure diagnosed and treated as SIF or AIF.…”

Section: Introductionmentioning

confidence: 99%

Correlation of histological and microbiological findings in septic and aseptic knee implant failure

Inagaki

Uchihara

Munemoto

et al. 2019

Arch Orthop Trauma Surg

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Introduction The Musculoskeletal Infection Society (MSIS) has defined specific clinical and laboratory criteria for the diagnosis of periprosthetic joint infection (PJI). In this study we assessed the diagnostic utility of MSIS microbiological and histological criteria for PJI in 138 cases of septic and aseptic knee implant failure. Materials and methods Intra-operative samples from 60 cases of knee septic implant failure (SIF) and 78 cases of aseptic implant failure (AIF), defined on the basis of clinical, laboratory and operative findings/surgical management, were analysed microbiologically and histologically. Findings were correlated with the final clinical diagnosis and the specificity, sensitivity, accuracy, positive and negative predictive value of MSIS microbiological and histological criteria for knee PJI were assessed. Results 80% of SIF cases showed culture of the same organism from two or more samples (ie MSIS microbiological criteria for definite PJI); 8.3% grew an organism from one sample, and 11.7% showed no growth from any sample. 23.1% of AIF cases grew an organism from one sample and 76.9% showed no growth from any sample. MSIS histological criteria for PJI identified 96.7% of SIF cases. The sensitivity, specificity, accuracy and positive and negative predictive value of MSIS histological criteria for PJI were 96.7%, 100%, 98.6%, 100% and 97.5%, respectively. MSIS microbiological and histological criteria identified all AIF cases. Conclusions Knee PJI is more often identified by current MSIS histological than microbiological criteria. A significant proportion of SIF cases show either no growth or growth of an organism from only one sample. AIF is identified by both MSIS microbiological and histological criteria. Correlation of clinical, radiological and laboratory findings is required for the diagnosis of knee PJI.

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Histopathology in Periprosthetic Joint Infection: When Will the Morphomolecular Diagnosis Be a Reality?

Cited by 24 publications

References 60 publications

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

Fabrication of PLLA/C3S Composite Membrane for the Prevention of Bone Cement Leakage

Plasma Cell Infiltration on Histopathological Samples of Chronic Bone and Joint Infections due to Cutibacterium acnes: A series of 21 Cases

Correlation of histological and microbiological findings in septic and aseptic knee implant failure

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