Annals of the Russian academy of medical sciencesAnnals of the Russian academy of medical sciencesВестник Российской академии медицинских наук0869-60472414-3545"Paediatrician" Publishers LLC837010.15690/vramn8370TRAUMATOLOGY: CURRENT ISSUESАКТУАЛЬНЫЕ ВОПРОСЫ ТРАВМАТОЛОГИИResearch ArticlePeriprosthetic Joint Infection as a Socio-Economic Problem of Modern OrthopedicsПерипротезная инфекция суставов как социально-экономическая проблема современной ортопедииhttps://orcid.org/0000-0002-2083-2424BozhkovaSvetlana A.БожковаСветлана Анатольевна
Russian Federation

MD, PhD

д.м.н.

clinpharm-rniito@yandex.ruhttps://orcid.org/0000-0003-0733-2414TikhilovRashid M.ТихиловРашид Муртузалиевич
Russian Federation

MD, PhD, Professor, Corresponding Member of the RAS

д.м.н., профессор, член-корреспондент РАН

rtikhilov@gmail.comhttps://orcid.org/0000-0002-5087-6081ArtyukhVasily A.АртюхВасилий Алексеевич
Russian Federation

MD, PhD

д.м.н.

artyukhva@mail.ruVreden National Medical Research Center of Traumatology and OrthopedicsНациональный медицинский исследовательский центр травматологии и ортопедии им. Р.Р. Вредена231220237866016082903202301122023Copyright ©; 2023, "Paediatrician" Publishers LLCCopyright ©; 2023, Издательство "Педиатръ"2023"Paediatrician" Publishers LLCИздательство "Педиатръ"https://vestnikramn.spr-journal.ru/jour/article/view/8370

Periprosthetic joint infection is the main social and economic problem of modern orthopedics with a recurrence rate of chronic forms of up to 23.2–31.5%. The aim of this review is to inform various specialties doctors about the features of pathogenesis, etiology and treatment of periprosthetic joint infection, which significantly differ it from of other surgical site infections. The severity of infectious complications is due to the suppression of the patient’s immune system and microbial biofilms. Surgical treatment of periprosthetic joint infection involves debridement with preservation or removal of the implants, resection arthroplasty and arthrodesis. Today, in the treatment of more than 80% of cases of chronic infection, a two-stage approach is used, which allows to restore joint function after an average of 1.0–1.5 years. An integral part of the treatment of patients is high-dose, long-term and combined antibiotic therapy, which allows you to effectively deal with the leading pathogens of periprosthetic infection Staphylococcus aureus and S. epidermidis, the share of which is 46.5–57.5%. In the conditions of growing resistance of bacteria to antibiotics, the interest of researchers in the possibilities of using bacteriophages in the complex therapy of infections of bones and joints has increased. The cost of treatment exceeds the cost of “aseptic” joint replacement by 2–24 times and is characterized by a high level of disability and mortality of patients. Taking into account the numerous factors affecting the course and effectiveness of complex treatment of patients with periprosthetic infection, a multidisciplinary approach is currently considered the main component of success. The medical and social significance and high financial costs of treating patients with periprosthetic infection indicate the need for further research and the active implementation of effective scientific developments in the practical healthcare system.

Перипротезная инфекция суставов является важной социально-экономической проблемой современной ортопедии с частотой рецидивов хронических форм до 23,2–31,5%. Затраты на лечение этого инфекционного осложнения превышают в 2–24 раза расходы на «асептическое» эндопротезирование и характеризуются высоким уровнем инвалидизации и летальности больных. Цель данного обзора — ознакомление врачей различных профилей о существующих особенностях патогенеза, этиологии и лечения перипротезной инфекции, которые существенно отличают ее от других инфекций области хирургического вмешательства. Тяжесть инфекционных осложнений в имплантологии обусловлена подавлением факторов иммунной защиты организма пациента и формированием микробных биопленок. Хирургическое лечение перипротезной инфекции предполагает радикальную хирургическую обработку с сохранением или удалением эндопротеза, резекционную артропластику и артродез сустава. Сегодня в лечении более 80% наблюдений хронической инфекции применяют двухэтапный подход, который позволяет восстановить функцию сустава в среднем через 1,0–1,5 года. Неотъемлемой частью лечения пациентов является большедозная, длительная и комбинированная антибактериальная терапия, позволяющая эффективно бороться с ведущими возбудителями перипротезной инфекции Staphylococcus aureus и S. epidermidis, доля которых составляет 46,5–57,5%. В условиях нарастающей резистентности бактерий к антибиотикам увеличился интерес исследователей к возможностям применения бактериофагов в комплексной терапии инфекции костей и суставов. С учетом многочисленных факторов, влияющих на течение и эффективность комплексного лечения пациентов с перипротезной инфекцией, основной составляющей успеха в настоящее время считают мультидисциплинарный подход. Медико-социальная значимость и высокие финансовые затраты на лечение пациентов с перипротезной инфекцией указывают на необходимость дальнейших исследований и активное внедрение эффективных научных разработок в систему практического здравоохранения.

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