Revision Total Knee Arthroplasty: Infection Should Be Ruled Out in All Cases

Harandi, A Aalami; Adeli, Bahar; Purtill, James J.; Parvızı, Javad

doi:10.1016/j.arth.2011.01.019

Cited by 38 publications

(26 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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

Self Cite

149

View full text Add to dashboard Cite

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.

show abstract

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

Self Cite

149

View full text Add to dashboard Cite

show abstract

“…The present study, which is an extension of a previous study and includes some patients previously reported on 17 , investigated the role that a novel pan-domain DNA-based amplification and analysis system, the Ibis T5000 biosensor (Isis Biosciences, Carlsbad, California [now a subsidiary of Abbott Laboratories, Abbott Park, Illinois]), may be able to play in improving the diagnosis of periprosthetic joint infection. We determined how frequently the Ibis identified the same organism and resistance genes as conventional culture in patients undergoing revision arthroplasty, as well as how frequently it identified additional organisms or resistance genes not seen by conventional culture.…”

mentioning

confidence: 99%

Successful Identification of Pathogens by Polymerase Chain Reaction (PCR)-Based Electron Spray Ionization Time-of-Flight Mass Spectrometry (ESI-TOF-MS) in Culture-Negative Periprosthetic Joint Infection

Jacovides¹,

Melton-Kreft²,

Adeli³

et al. 2012

The Journal of Bone and Joint Surgery-American Volume

Self Cite

133

109

View full text Add to dashboard Cite

show abstract

“…Die medizinisch bedeutsamste und innerhalb der ersten 2 Jahre häufigste Revisionsursache ist die PPI. Die Diagnose erscheint in der Praxis schwierig, da ein signifikanter Anteil von Lowgrade-Infektionen fälschlicherweise als aseptisch diagnostiziert wird [13]. Daher sollte bei jedem Patienten mit einer unklaren Schmerzsymptomatik bis zum Beweis des Gegenteils eine PPI angenommen werden.…”

Section: Diskussionunclassified

Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

et al. 2015

View full text Add to dashboard Cite

Basic building blocks are the medical history with the core issues of pain character and the time curve of pain concerning surgery. This is followed by the basic diagnostics, including clinical, radiological, and infectiological investigations. Unique failures like periprosthetic infection or aseptic loosening can thereby be diagnosed in the majority of cases. If the cause of pain is not clearly attributable using the basic diagnostics tool, further infectiological investigation or diagnostic imaging are necessary. If the findings are inconsistent, uncommon causes of symptoms, such as extra-articular pathologies, causalgia or arthrofibrosis, have to be considered. In cases of ongoing unexplained pain, a revision is not indicated. These patients should be re-evaluated after a period of time.

show abstract

Revision Total Knee Arthroplasty: Infection Should Be Ruled Out in All Cases

Cited by 38 publications

References 30 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

Successful Identification of Pathogens by Polymerase Chain Reaction (PCR)-Based Electron Spray Ionization Time-of-Flight Mass Spectrometry (ESI-TOF-MS) in Culture-Negative Periprosthetic Joint Infection

Berliner diagnostischer Algorithmus der schmerzhaften Knie-TEP

Contact Info

Product

Resources

About