NEW LAB TECHNIQUES HELP TREAT JOINT REPLACEMENT PAIN

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New Lab Techniques Help Treat Joint Replacement Pain

ArthritisSupport.com

09-18-2002 A team of scientists and doctors at the University of

Edinburgh are using new laboratory techniques that will lead to improved

treatment for patients experiencing problems with joint replacement.

The multi-disciplinary team will try to establish if using

molecular techniques can set a gold standard to allow doctors to know

before surgery is carried out whether a joint replacement has loosened due

to wear (aseptic) or infection (septic). This prior knowledge is of critical

importance to the surgical team, which uses different treatment, depending

on whether infection is present, or absent. For instance, loose hip

replacements are usually revised in one stage if they are not infected,

but in two stages if the loosening has been caused by infection.

Professor Hamish Simpson of the Musculoskeletal Research Unit at

the Universitys Medical School explained: Joint replacement surgery has

been a major advance in the treatment of arthritis, and more than 100,000

hip, knee, shoulder and elbow joint replacement operations are carried out

in the UK each year. As a consequence of an ageing population and the

success of these procedures, the numbers are rising. However, failure of the

joint replacement occurs in a significant proportion of cases, which then

require revision surgery.

A loose hip causes the patient pain on movement. It is

essential to know, prior to the revision operation, whether this loosening

has been caused by wear or infection, but current methods for diagnosing

joint replacement infection pre-operatively are inaccurate. The surgeon then

has to rely on techniques during the operation. The failure to diagnose

joint replacement infection has serious consequences for the patient.

The research team aims to look at the value of employing

established molecular techniques (using the polymerase chain reaction-PCR)

for diagnosing infection at the pre-operative stage in joint replacement

failure. PCR techniques involve taking a sample of tissue from the patient

and, under laboratory conditions, establishing whether bacterial DNA is

present, which would show there was infection.

Professor Simpson said there might be a high false positive rate

with this test, so the research study would have to establish if this method

was sufficiently sensitive and specific enough to be useful as a clinical

tool.

The study, funded by a grant from the Chief Scientist Office,

will last for three years

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