Influence of Microbial Contamination of Bone Tissue on Its Regenerator Potential in Total Artroplasty in Patients With Rheumatoid Arthritis

Abstract

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.