Is Aseptic Loosening Truly Aseptic?

Nelson, Carl L.; McLaren, A. C.; McLaren, Sandra G.; Johnson, Jeffrey W.; Smeltzer, Mark S.

doi:10.1097/01.blo.0000175715.68624.3d

Cited by 140 publications

(109 citation statements)

References 25 publications

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“…However, we opted to grow cultures from aseptic cases for less than 2 weeks due to concerns of contaminant growth and thus overly inflated false-positive results. Second, several studies [11,17,20] have recently debated categorizing all aseptic revisions as truly aseptic, especially if there is positive intraoperative culture growth and subsequent need for rerevision due to infection. Although it is Table 3.…”

Section: Discussionmentioning

confidence: 99%

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

Aggarwal

Deirmengian

Parvızı

et al. 2013

Clinical Orthopaedics &Amp; Related Research

145

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Background While it is accepted accurate identification of infecting organisms is crucial in guiding treatment of periprosthetic joint infection (PJI), there remains no consensus regarding the best method for obtaining cultures. Questions/purposes We compared the yield of intraoperative tissue samples versus swab cultures in diagnosing PJI. Methods Tissue and swab cultures (three each) were collected prospectively during a consecutive series of 156 aseptic and septic revision arthroplasties from October 2011 to April 2012. The tissues and swabs were taken from standardized regions of the joint. After excluding 39 reimplantation procedures, we included 117 cases (74 hip, 43 knee; 30 septic, 87 aseptic) for analysis. We used a modified version of the Musculoskeletal Infection Society criteria for defining PJI, requiring three of five rather than four of six criteria. Tissue and swab cultures from septic and aseptic cases were used to calculate their sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for identifying PJI. Results Tissue cultures were positive in a higher percentage of septic cases than swab cultures: 28 of 30 (93%) versus 21 of 30 (70%). Tissue cultures were positive in two of 87 aseptic cases (2%), while swab cultures were positive in 10 of 87 (12%). The sensitivity, specificity, PPV, and NPV were 93%, 98%, 93%, and 98%, respectively, for tissue cultures and 70%, 89%, 68%, and 90%, respectively, for swab cultures. Conclusions Tissue cultures demonstrated higher sensitivity, specificity, PPV, and NPV for diagnosing PJI than swab cultures. Swab cultures had more false-negative and false-positive results than tissue cultures. Because swab cultures pose a higher risk of not identifying or incorrectly identifying infecting organisms in PJI, we believe their use in obtaining intraoperative culture specimens should be discouraged.

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Section: Discussionmentioning

confidence: 99%

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

Aggarwal

Deirmengian

Parvızı

et al. 2013

Clinical Orthopaedics &Amp; Related Research

145

View full text Add to dashboard Cite

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“…The suspicion that some of the aseptic cases are not truly aseptic is not new [12,14]. Nelson et al suggested that septic loosening as defined by the failure to observe clinical signs of infection and/or to isolate bacteria using standard microbiologic techniques does not completely eliminate the possibility of PJI [20]. Spangehl et al, reporting on 202 revision THAs [27], observed that ESR and CRP values do not necessarily increase concomitantly in every infected hip.…”

Section: Discussionmentioning

confidence: 99%

“…Mechanisms such as the presence of a biofilm and/or internalization of an organism by osteoblasts [3,20,21,28] cause the infecting organism to escape detection by conventional methods. There is no preoperative test that has consistent 100% sensitivity and specificity.…”

Section: Discussionmentioning

confidence: 99%

“…Sonication of retrieved implants suggests bacteria were present in 77% of so-called aseptic cases [12]. Therefore, it is plausible that some cases of subclinical infection masquerade as aseptic failure [9,10,20], and inability to isolate the infecting organisms may lead to implementation of surgical interventions that may be inappropriate. Some patients may have had indicators of PJI that had not been considered important.…”

Section: Introductionmentioning

confidence: 99%

“…One of the main reasons for inability to isolate the infecting organism relates to the presence of a biofilm [7,20] and/or internalization of the organism by osteoblasts [18,20]. Biofilm is a complex structure comprising microorganisms enveloped in macromolecules of glycocalyx and other protective films [7,16].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Aseptic Loosening of Total Hip Arthroplasty: Infection Always Should be Ruled Out

Parvızı

Suh

Jafari

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background It is believed that some cases of aseptic failure of THA may be attributable to occult infections. However, it is unclear whether preoperative erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are more likely elevated in these patients than those without overt infection. Questions/purposes We asked whether some patients with aseptic THA failures have abnormal serologic indicators of periprosthetic joint infection (PJI) at the time of revision, namely ESR and/or CRP. Methods Three hundred twenty-three revision THAs for aseptic loosening from 2004 to 2007 were retrospectively evaluated. We categorized all cases into two groups:(1) those with overt PJI (n = 14) plus patients who had a positive intraoperative culture during the index revision (n = 13) and (2) those who did not require rerevision (n = 276) or required surgery for noninfected causes (n = 20). Mean and frequency of abnormal ESR and CRP were compared between the two groups. The minimum followup was 11 months (average, 35 months; range, 11-54 months). Results The mean and frequency of abnormal CRP in first group (n = 27) at 2.1 mg/dL and 48% respectively, were greater than those of the uninfected (n = 296) at 1.2 mg/dL and 27%, respectively. However, there were no differences between two groups regarding mean or frequency of abnormal ESR.

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Vulcanized paper for separation of alcohol aqueous solutions by pervaporation

Trang

Kobayashi

2011

J of Applied Polymer Sci

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Paper membranes made from vulcanized cellulose were used for the pervaporation (PV) of aqueous solutions containing methanol, ethanol, and isopropanol. It was noted that the vulcanized cellulose paper membranes (VCPM) could effectively separate alcohol and water from the mixture solutions. To observe the effect of the separation of alcohol aqueous mixtures, the permeation behavior of water and alcohol was examined by means of the separation factor and the permeation flux. The values of the permeation flux in the ethanol/water mixtures were found to vary from 6.2 kg/m 2 h to 2.1 kg/m 2 h, as the concentration of ethanol increased from 8 to 87 wt %, and the separation factor (a) changed from a ¼ 2.6 to 6.6, respectively. This showed that the VCPM enhanced the separation of water and alcohol. The highest value observed for the permeation flux was 11 kg/m 2 h at 87 wt % of methanol con-centration and the separation factor at this condition was 4.1. It was shown also that an efficient separation was obtained in the isopropanol/water mixture with a separation factor of 16.6. The contact angles of alcohol/water droplets on the VCPM were measured as well as the wettability of the membrane. There was a tendency of decrease for the contact angle, as the alcohol concentration decreased. This suggested that the solvent wettability decreased in high alcohol concentrations. It was concluded that a high permeabilitty of water through the VCPM resulted in the separation of alcohols and water in the PV process.

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Is Aseptic Loosening Truly Aseptic?

Cited by 140 publications

References 25 publications

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

Swab Cultures Are Not As Effective As Tissue Cultures for Diagnosis of Periprosthetic Joint Infection

Aseptic Loosening of Total Hip Arthroplasty: Infection Always Should be Ruled Out

Vulcanized paper for separation of alcohol aqueous solutions by pervaporation

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