Assessing the Dynamics of Hematological Parameters for Early Diagnosis of Peri-Prosthetic Infection in Patients after Knee and Hip Joint Arthroplasty

The article deals with the issues concerning dynamics of hematological parameters and their diagnostic sensitivity in patients after arthroplasty of the hip and knee joints for the early diagnosis of peri-prosthesis infection. Material and methods. A total of 56 patients underwent arthroplasty of the knee (n=42) and hip (n=14) joints, among them 16 patients were men and 37 women. The age of the patients was from 35 to 79. All patients were divided into three groups: the first group – patients who had been diagnosed with peri-prosthesis infection for up to 4 weeks after surgery (n=7); the second group – patients who were diagnosed when admitted to the clinic, but the postoperative period was with complications (n=8); the third group – patients with normal postoperative course (n=46). We determined the number of red blood cells and leukocytes, hemoglobin, erythrocyte sedimentation rate (ESR) and leukogram in all patients. Diagnostic sensitivity (DS) of laboratory parameters was calculated according to the formula DS = (TP / D-) × 100 %, where TP is truly positive results of the study, D- is the number of patients in the group. We examined 30 clinically healthy individuals (15 men and 15 women aged from 25 to 65) as a control group. Results and discussion. The course of study showed that there was anemia associated with blood loss during the operation and in the early postoperative period in patients after endoprosthetics of the hip and knee joints, irrespective of the detection of peri-prosthetic infection. In patients of the first group, where in the postoperative period patients were diagnosed with complications of periprosthesis infection, an increase in the content of total leukocytes and neutrophilia in the blood for 2 days after surgery with subsequent decrease of this indicator to the control group. The level of ESR was increased on the 2nd, 7th, and 14th days after arthroplasty. Patients in the second group had neutrophilia for 2 days after the operation, their level of ESR increased before surgery and remained elevated in the postoperative period. Patients in the third group, who had no peri-prosthesis infection, showed changes in leukogram only 2 days after surgery in the form of decreasing the relative number of segmental neutrophils and the number of lymphocytes. The increase in ESR was on the 2nd, 7th, and 14th days after the operation and was lower compared with the I and II groups of patients. This may indicate a favorable postoperative period. Conclusions. Diagnostic sensitivity in all groups of patients in the postoperative period was the highest in ESR, erythrocytes and hemoglobin, and the lowest in leukocytes, which does not allow considering this parameter as a laboratory test for the diagnosis of peri-prosthetic infection.