Estimation of impact of remodeling and microbial factors on the results of total endoprosthesis of a knee joint in patients, suffering rheumatoid arthritis

Abstract

Objective. To estimate the impact of remodelling and microbial factors on the results of total endoprosthesis (ТЕP) of the knee joint in patients, suffering rheumatoid arthritis (RА). Маterials and methods. The results of microbiological investigations of operative specimen were compared with results of cloning of the stem stromal cells of the bone marrow. Міcrobiologically and microscopically there were studied 247 specimen of operative material, obtained during performance of primary TЕP of a knee joint in 64 patients, suffering RA. Results. As the investigations have shown, in 1 сm³ of spongious bone of distal femur there is in 1.4 times more a general quantity of cells, containing the nuclei, than in 1 сm3 of spongious bone of proximal tibiae (the difference is not statistically significant). In distal part of femur the quantity of a colony-creating units of fibroblasts (CCUF) in 1 сm³ is in a 9.8 times lower, than the CCUF quantity in 1 сm³ in proximal part of tibiae (the difference is statistically significant), аnd the efficacy of the CCUF cloning is accordingly more than in 2.1 times lower (difference is statistically nonsignificant). Conclusion. High level of contamination of predominantly gram-positive microorganisms of the bone operative material, obtained while primary TEP of a knee joint in 82.8% patients, suffering RA, have a strong (almost a functional one) linear adverse correlation (coefficient r = -0.98) with osteogenic аctivity of the stem stromal cells in the bone marrow, which form a knee joint, what necessitates overestimation of approaches, concerning preparation and performance of surgical intervention for guaranteeing the efficacy of orthopedic treatment and standards of the protocols.

Keywords

• rheumatoid arthritis; total endoprosthesis; the knee joint