METHOD FOR DETERMINING A SURGICAL APPROACH TO INSPECTING ENDOPROSTHESIS REPLACEMENT OF LARGE JOINTS IN AN INFECTIOUS COMPLICATION Russian patent published in 2019 - IPC A61B17/56 

FIELD: medicine.

SUBSTANCE: method for determining a surgical approach to inspecting endoprosthesis replacement of large joints in infectious complications refers to medicine, namely to traumatology, orthopedics and purulent surgery, and can be recommended for use after primary replacement arthroplasty with presence of objective clinical signs of periprosthetic infection. Essence of the proposed method for determining a surgical approach to revision endoprosthesis replacement of large joints in case of infectious complication involves assessing the state of soft tissues in the area of the prosthetic joint and having previous revision-sanation operations in the endoprosthesis. New in the disclosed method is that additionally analyzing the patient's peripheral blood, namely segmented neutrophils and monocytes, thereafter, the degree of risk of the infectious process following the revision surgery is determined by using the patient's score. Thus, if the patient has an unsatisfactory condition of soft tissues in the area of the prosthetic joint (fistula) – 2 points are scored, if observing hyperaemia, soft tissue edema – 1 point, in the absence of local clinical manifestations in soft tissues, 0 points are scored, if there is a previous revision-sanation surgery on the prosthetic joint, 1 point is scored, while in the case of audits more than one, 2 points is scored, in the absence of revision-sanation operations – 0 points. If the ratio of segmented neutrophils to monocytes >12 units is 1 point, ≤12 units – 0 points. If the score is from 0 to 2, a low risk level is predicted, and a single-stage revision endoprosthesis replacement is performed; if the total score is 3 or more, a high risk is predicted and a two-stage prosthetic repair is performed.

EFFECT: disclosed method enables higher clinical effectiveness in infectious complications of endoprosthesis replacement, simplifies the determination of the endoprosthesis replacement therapy in periprosthetic infection without compromising quality and objectivity of diagnostics (single-stage or two-stage audit), reduced time of patient examination due to exclusion of studies in operating and specialized laboratories, reduced economic costs for examination and treatment for institution and patient, as determination of therapeutic approach is performed at pre-hospital stage and available for doctor.

1 cl, 8 dwg