LYMPHOCYTE POPULATIONS IN PATIENTS WITH PERIPROSTHETIC INFECTION OF THE HIP JOINT
Objective. To study the peculiarities of cell-mediated immunity in patients with periprosthetic hip joint infection depending on disease severity and according to the method of surgical intervention, subsequently used. Methods. The values of cell-mediated immunity were studied at the preoperative stage in patients (n=66) with periprosthetic hip joint infection who were divided into three groups: Group I (n=13) - debridement of the infected joint with the replacement of the implant modular components; Group II (n=36) - articulating spacer installation; Group III (n=17) - resection arthroplasty. Lymphocyte subpopulations were studied by laser flow cytofluorimetry method. Results. In comparison of the cell immunity values in groups I, II, III with those of the control group there was observed the absence of subpopulation alterations in group I, as well as the elevation of relative content of СD3+СD8+ for normal content of СD3+СD4+ in group II; the elevation of both relative and absolute values of СD3+СD8+ while reduction of the values of СD3+СD4+ in group III. The content of activated T-lymphocytes was elevated in all three groups. A Kruskal-Wallis test to analyze 3 groups revealed significant difference between the groups (I, II, III) regarding the immunoregulatory index (CD4/CD3); (H-6,67; р=0,035). There was statistically significant difference between Groups I-III (p=0,012) and between groups II-III (p=0,011). Intergroup difference was also identified regarding СD3+СD4+ (%); (H-22,57; р=0,0003). Statistically significant difference was determined between groups I-III (p=0,0002) and between Groups II-III (p=0,0003). Conclusions. The alterations in lymphocyte population composition can be considered as an informative marker of severe infection. The study of T-lymphocyte subpopulations Т-helpers (СD3+СD4+) and cytotoxic T-lymphocytes (СD3+СD8+)) can be used to reveal immuno-compromised patients. These values can be regarded as additional diagnostic tests to select theoptimal surgical treatment of periprosthetic infection. What this paper adds For the first time at the preoperative stage, lymphocyte population composition have been analyzed in patients with periprosthetic hip infection depending on disease severity and according to the method of surgical intervention, used later (debridement of the infected joint with replacement of modular components of the endoprosthesis, installation of an articulating spacer, resection arthroplasty). It has been established that the study of subpopulations of T-lymphocytes can be considered as an additional diagnostic criterion for choosing the optimal surgical treatment of periprosthetic infection.