Prevalence and Outcomes of Unexpected Positive Cultures in Presumed Aseptic Revision Total Hip Arthroplasty
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Published:
Oct 24, 2022
Keywords:
Hip arthroplasty, hip revision surgery, microorganism, periprosthetic infections
Main Article Content
Abstract
Introduction: Periprosthetic infection rates are sometimes underestimated, as many cases of presumed aseptic failure may be due to unrecognized infection. The objectives of the present study of aseptic revision THA were: (1) to estimate the prevalence of unexpected positive intraoperative cultures; (2) to determine if any of the patient’s comorbidities or risk factors were related to the presence of unexpected positive cultures; (3) to determine the implant survival during the follow-up of at least 12 months.
Methods: A retrospective and observational study was carried out where, through electronic medical records, all revisions total hip arthroplasty (THA) from a single institution between 2014 and 2021 were identified.
Results: Of the 49 revisions THA in 1 time, 9 patients (18.4%) had an unexpected positive culture. The isolated microorganisms were Staphylococcus aureus (3), Pseudomonas aeruginosa (1), Staphylococcus lugdunensis (1), Staphylococcus epidermidis (2), Staphylococcus haemolyticus (1), Streptococcus epidermidis (1). In addition, when we evaluated the comorbidities of the patients, none had statistical significance in favoring unexpected positive cultures in aseptic revisions. We found out that 2% of our sample with a follow-up period of 49 months developed reinfection.
Conclusion: Our study showed a prevalence of unexpected positive cultures of 18.4%. None of the risk factors reported in the literature was associated with a higher risk of unexpected positive cultures in these aseptic check-ups, except for high ESR values. Our findings suggest that unexpected positive cultures in presumably aseptic reviews do not have significant consequences on implant survival, as found in the literature.
Methods: A retrospective and observational study was carried out where, through electronic medical records, all revisions total hip arthroplasty (THA) from a single institution between 2014 and 2021 were identified.
Results: Of the 49 revisions THA in 1 time, 9 patients (18.4%) had an unexpected positive culture. The isolated microorganisms were Staphylococcus aureus (3), Pseudomonas aeruginosa (1), Staphylococcus lugdunensis (1), Staphylococcus epidermidis (2), Staphylococcus haemolyticus (1), Streptococcus epidermidis (1). In addition, when we evaluated the comorbidities of the patients, none had statistical significance in favoring unexpected positive cultures in aseptic revisions. We found out that 2% of our sample with a follow-up period of 49 months developed reinfection.
Conclusion: Our study showed a prevalence of unexpected positive cultures of 18.4%. None of the risk factors reported in the literature was associated with a higher risk of unexpected positive cultures in these aseptic check-ups, except for high ESR values. Our findings suggest that unexpected positive cultures in presumably aseptic reviews do not have significant consequences on implant survival, as found in the literature.
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How to Cite
Paz, M. L., Iglesias, S. L., López, P. D., Almada, A. G., Romero, F., Mangupli, M. M., Pioli, I. J., Gómez, J. M., & Allende, B. L. (2022). Prevalence and Outcomes of Unexpected Positive Cultures in Presumed Aseptic Revision Total Hip Arthroplasty. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(5), 645-651. https://doi.org/10.15417/issn.1852-7434.2022.87.5.1611
Section
Clinical Research
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References
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United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
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4. Neufeld ME, Lanting BA, Shehata M, Howard JL, MacDonald SJ, Teeter MG, et al. Prevalence and outcomes of
unexpected positive intraoperative cultures in presumed aseptic revision hip arthroplasty. J Bone Joint Surg Am
2021;103(15):1392-1401. https://doi.org/10.2106/JBJS.20.01559
5. Purudappa PP, Sharma OP, Priyavadana S, Sambandam S, Villafuerte JA. Unexpected positive intraoperative
cultures (UPIC) in revision hip and knee arthroplasty. A review of the literature. J Orthop 2019;17:1-6. https://doi.org/10.1016/j.jor.2019.06.028
6. Parvizi J, Suh D-H, Jafari SM, Mullan A, Purtill JJ. Aseptic loosening of total hip arthroplasty: infection always
should be ruled out. Clin Orthop Relat Res 2011;469(5):1401-5. https://doi.org/10.1007/s11999-011-1822-1
7. Staats K, Kolbitsch P, Sigmund IK, Hobusch GM, Holinka J, Windhager R. Outcome of total hip and total
knee revision arthroplasty with minor infection criteria: A retrospective matched-pair analysis. J Arthroplasty
2017;32(4):1266-71. https://doi.org/10.1016/j.arth.2016.11.06
8. Schwarze J, Dieckmann R, Gosheger G, Bensmann M, Moellenbeck B, Theil C. Unsuspected positive cultures
in planned aseptic revision knee or hip arthroplasty - risk factors and impact on survivorship. J Arthroplasty
2022;37(6):1165-72. https://doi.org/10.1016/j.arth.2022.02.054
9. Milandt NR, Gundtoft PH, Overgaard S. A single positive tissue culture increases the risk of rerevision of clinically aseptic THA: A National Register Study. Clin Orthop Relat Res 2019;477(6):1372-81. https://doi.org/10.1097/CORR.0000000000000609
10. Jacobs AME, Bénard M, Meis JF, van Hellemondt G, Goosen JHM. The unsuspected prosthetic joint infection:
incidence and consequences of positive intra-operative cultures in presumed aseptic knee and hip revisions. Bone Joint J 2017; 99-B(11):1482-9. https://doi.org/10.1302/0301-620X.99B11.BJJ-2016-0655.R2
11. Boot W, Moojen DJF, Visser E, Mechteld Lehr A, De Windt TS, Van Hellemondt G, et al. Missed low-grade
infection in suspected aseptic loosening has no consequences for the survival of total hip arthroplasty. Acta Orthop 2015;86(6):678-83. https://doi.org/10.3109/17453674.2015.1086942
hip and knee replacement in the United States. J Bone Joint Surg Am 2015;97(17):1386-97. https://doi.org/10.2106/JBJS.N.01141
2. Kurtz S, Ong K, Lau E, Mowat F, Halpern M. Projections of primary and revision hip and knee arthroplasty in the
United States from 2005 to 2030. J Bone Joint Surg Am 2007;89(4):780-5. https://doi.org/10.2106/JBJS.F.00222
3. Labek G, Thaler M, Janda W, Agreiter M, Stöckl B. Revision rates after total joint replacement: cumulative results from worldwide joint register datasets. J Bone Joint Surg Br 2011;93(3):293-7. https://doi.org/10.1302/0301-620X.93B3.25467
4. Neufeld ME, Lanting BA, Shehata M, Howard JL, MacDonald SJ, Teeter MG, et al. Prevalence and outcomes of
unexpected positive intraoperative cultures in presumed aseptic revision hip arthroplasty. J Bone Joint Surg Am
2021;103(15):1392-1401. https://doi.org/10.2106/JBJS.20.01559
5. Purudappa PP, Sharma OP, Priyavadana S, Sambandam S, Villafuerte JA. Unexpected positive intraoperative
cultures (UPIC) in revision hip and knee arthroplasty. A review of the literature. J Orthop 2019;17:1-6. https://doi.org/10.1016/j.jor.2019.06.028
6. Parvizi J, Suh D-H, Jafari SM, Mullan A, Purtill JJ. Aseptic loosening of total hip arthroplasty: infection always
should be ruled out. Clin Orthop Relat Res 2011;469(5):1401-5. https://doi.org/10.1007/s11999-011-1822-1
7. Staats K, Kolbitsch P, Sigmund IK, Hobusch GM, Holinka J, Windhager R. Outcome of total hip and total
knee revision arthroplasty with minor infection criteria: A retrospective matched-pair analysis. J Arthroplasty
2017;32(4):1266-71. https://doi.org/10.1016/j.arth.2016.11.06
8. Schwarze J, Dieckmann R, Gosheger G, Bensmann M, Moellenbeck B, Theil C. Unsuspected positive cultures
in planned aseptic revision knee or hip arthroplasty - risk factors and impact on survivorship. J Arthroplasty
2022;37(6):1165-72. https://doi.org/10.1016/j.arth.2022.02.054
9. Milandt NR, Gundtoft PH, Overgaard S. A single positive tissue culture increases the risk of rerevision of clinically aseptic THA: A National Register Study. Clin Orthop Relat Res 2019;477(6):1372-81. https://doi.org/10.1097/CORR.0000000000000609
10. Jacobs AME, Bénard M, Meis JF, van Hellemondt G, Goosen JHM. The unsuspected prosthetic joint infection:
incidence and consequences of positive intra-operative cultures in presumed aseptic knee and hip revisions. Bone Joint J 2017; 99-B(11):1482-9. https://doi.org/10.1302/0301-620X.99B11.BJJ-2016-0655.R2
11. Boot W, Moojen DJF, Visser E, Mechteld Lehr A, De Windt TS, Van Hellemondt G, et al. Missed low-grade
infection in suspected aseptic loosening has no consequences for the survival of total hip arthroplasty. Acta Orthop 2015;86(6):678-83. https://doi.org/10.3109/17453674.2015.1086942