A Single Positive Tissue Culture Increases the Risk of Rerevision of Clinically Aseptic THA: A National Register Study

Milandt, Nikolaj; Gundtoft, Per Hviid; Overgaard, Søren

doi:10.1097/corr.0000000000000609

Cited by 24 publications

(28 citation statements)

References 24 publications

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“…Whereas low-grade PJI is mostly presenting with early loosening, or pain only, it can be very difficult to diagnose. During recent years, we have become increasingly aware that, in addition to obvious PJI, there is an important but unknown number of septic failures-PJI hiding within "aseptic failure" cohorts [5][6][7]. Recent papers are presenting significant numbers of up to 20% of lowgrade PJI within presumed aseptic failure cohorts [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…During recent years, we have become increasingly aware that, in addition to obvious PJI, there is an important but unknown number of septic failures-PJI hiding within "aseptic failure" cohorts [5][6][7]. Recent papers are presenting significant numbers of up to 20% of lowgrade PJI within presumed aseptic failure cohorts [7,8]. Many early failures after revision TJA fit within this overlooked PJI group [7][8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Trebše

Roškar

2021

International Orthopaedics (SICOT)

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Background Total joint arthroplasty (TJA) is considered one of the most successful surgical procedures ever developed. It can successfully provide pain relief, restore joint function, and improve mobility and quality of life. Prosthetic joint infection (PJI) presents with a wide variety and severity of signs and symptoms. It remains a major threat to the outcome of TJA procedures and usually necessitates surgical intervention and prolonged courses of antibiotics. Inappropriate treatment of an unrecognized PJI usually ends with unacceptable and sometimes catastrophic results. The aim The understanding and evaluation of diagnostic investigations are extremely important to properly diagnose PJI, including frequently unrecognized low-grade infections, and to provide healthcare professionals with needed information for the care of patients affected by this condition. This article aims to review most of the methods available in PJI diagnostics, to emphasize the strengths and the weaknesses of each of them, and to provide a guideline on how to select the surgical treatment strategy based on the level of diagnostic certainty during the evaluation period. To safely accomplish this, it is crucial to be aware of the limitations of each diagnostic modality. The focus The emphasis will be on the use and interpretation of the core criteria for PJI diagnosis, including the pathognomonic sinus tract communicating with the implant, purulent synovial fluid, inflammation in the periprosthetic tissue, cell count with differential, microbial growth in the synovial fluid culture, tissue sample cultures, and sonication samples.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Trebše

Roškar

2021

International Orthopaedics (SICOT)

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“…The present study reported an incidence of unexpected PJIs of 20%. This value is higher compared to what previously reported in the literature [7][8][9][10][11][12][13], particularly for the THA revision (22.4% versus 12.1%) compared with TKA revision (11.1% versus 7.9%) [9]. The discrepancy is mostly due to the heterogeneity of the criteria for defining an unexpected PJI.…”

Section: Discussionmentioning

confidence: 57%

“…Since the diagnosis often results from the data collected during surgery, the incidence of PJIs is likely higher than reported by joint registries. Previous authors reported that the rate of PJIs in patients undergoing aseptic Level of evidence: level IV, case series revision arthroplasties ranges from 6 to 13.5% [7][8][9][10][11][12][13]. However, the outcome of patients with unexpected positive intra-operative cultures during prosthetic revision surgery for presumed aseptic failure is still unclear.…”

Section: Introductionmentioning

confidence: 99%

“…However, the outcome of patients with unexpected positive intra-operative cultures during prosthetic revision surgery for presumed aseptic failure is still unclear. Some authors reported a higher risk of re-revision for any causes and infection in patients with unexpected PJIs when compared with patients undergoing culture-negative revision [7,9]. On the other hand, some authors reported no statistically significant difference in the number of re-revisions between the unexpected PJI group and the aseptic loosening group [11,13].…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of patients with unexpected diagnosis of infection at total hip or total knee arthroplasty revisions

Loppini

Pisano

Maio

et al. 2021

International Orthopaedics (SICOT)

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Purpose The pre-operative differential diagnosis between periprosthetic joint infections (PJIs) and aseptic failure is challenging particularly in low virulence and biofilm-related infections. This study aimed to assess the incidence and survival of patients with unexpected PJIs in a presumed aseptic revision of total hip (THA) and knee (TKA) arthroplasties. Methods A retrospective analysis of a prospective cohort of patients was performed with 295 patients undergoing THA (n = 241) or TKA (n = 54) revision for presumed aseptic causes. Patients were diagnosed with unexpected PJI taking into account leukocyte count in the synovial fluid, sonicate, synovial culture, and tissue cultures of samples collected during surgery. The primary endpoint was the infection-free implant survival rate at theone year follow-up. ResultsThe unexpected PJIs were 60 out of 295 (20.3%), whereas 235 (79.7%) were aseptic revisions. In the unexpected PJI group, 6 (11.1%) patients underwent knee revision and 54 (22.4%) hip revision. At the one year follow-up, one patient (1.6%) in the unexpected PJI group and 3 (1.3%) in the aseptic group (p = 1.0) failed for infection. The infection-free implant survival rate at the one year follow-up was 98.3% (C.I. 95%, 94.9-99.9%) for the unexpected PJI group and 98.7% (C.I. 95%, 97.3-99.9%) (p = 0.82) for the aseptic group. ConclusionThe incidence of unexpected PJIs in a presumed aseptic revision of THAs and TKAs has been previously underestimated. The infection-free implant survival rate at the one year follow-up in patients with unexpected PJIs was not significantly lower compared with patients undergoing aseptic revision.

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Alpha-defensin as a diagnostic tool in revision total knee arthroplasties with unexpected positive intraoperative cultures and unexpected culture negative intraoperative cultures

Simon

Frank²,

Aichmair³

et al. 2022

Knee Surg Sports Traumatol Arthrosc

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Purpose Unexpected-positive-intraoperative-cultures (UPIC) are common in presumed aseptic revision-total-knee-arthroplasties (rTKA). However, the clinical signiicance is not entirely clear. In contrast, in some presumably septic rTKA, identiication of an underlying pathogen was not possible, so-called unexpected-negative-intraoperative-cultures (UNIC). The purpose of this study was to evaluate the potential use of synovial alpha-defensin (AD) levels in these patients. Methods Synovial AD levels from 143 rTKAs were evaluated retrospectively from our prospectively maintained institutional periprostetic joint infection (PJI) biobank and database. The 2018-International Consensus Meeting (ICM) criteria was used to deine the study groups. Samples from UPICs with a minimum of one positive intraoperative culture (ICM 2-≥ 6) (n = 20) and UNIC's (ICM ≥ 6) (n = 14) were compared to 34 septic culture-positive samples (ICM ≥ 6) and 75 aseptic culture-negative (ICM 0-1). Moreover, AD-lateral-low-assay (ADLF) and an enzyme-linked-immunosorbent-assay (ELISA) in detecting the presence of AD in native and centrifuged synovial luid specimens was performed. Concentration of AD determined by ELISA and ADLF methods, as well as microbiological, and histopathological results, serum and synovial parameters along with demographic factors were analysed. Results AD was positive in 31/34 (91.2%) samples from the septic culture-positive group and in 14/14 (100%) samples in the UNIC group. All UPIC samples showed a negative AD result. Positive AD samples were highly associated with culture positive and histopathological results (p < 0.001). No high-virulent microorganisms (0/20) were present in the UPIC group, compared to infected-group (19/34; 55.9%). High virulent microorganisms showed a positive AD result in 89.5% (17/19) of the cases. Methicillin resistant Staphylococcus epidermis (MRSE) infections had signiicantly higher AD levels than with methicillin susceptible S. epidermdis (MSSE) (p = 0.003). ELISA and ADLF tests were positive with centrifuged (8/8) and native (8/8) synovial luid. Conclusion AD showed a solid diagnostic performance in infected and non-infected revisions, and it provided an additional value in the diagnosis of UPIC and UNIC associated to rTKAs. Pathogen virulence as well as antibiotic resistance pattern may have an efect on AD levels. Centrifugation of synovial luid had no inluence on ADLF results.

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A Single Positive Tissue Culture Increases the Risk of Rerevision of Clinically Aseptic THA: A National Register Study

Cited by 24 publications

References 24 publications

Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Evaluation and interpretation of prosthetic joint infection diagnostic investigations

Outcomes of patients with unexpected diagnosis of infection at total hip or total knee arthroplasty revisions

Alpha-defensin as a diagnostic tool in revision total knee arthroplasties with unexpected positive intraoperative cultures and unexpected culture negative intraoperative cultures

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