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Updated: Aug 14, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Arthroplastic and osteosynthetic infections due to Propionibacterium acnes: a retrospective study of 52 cases,
M-F Lutz1, P Berthelot, A Fresard
1Infectious Diseases Department, University Hospital of Saint-Etienne, 42055 Saint-Etienne, Cedex 2, France.
Abstract:
The cases of 52 patients with Propionibacterium acnes infection of orthopaedic implants are summarized: 20 patients with definite infection (sepsis, with P. acnes recovered from multiple specimens per patient), 15 with probable infection (sepsis, with P. acnes recovered from one specimen), and 17 with possible infection (signs of prosthetic malfunction or pseudo-osteoarthritis, with P. acnes recovered from one specimen). The patient population consisted of 37 males and 15 females with a mean age of 51.8 years (range 17-88). Besides bone surgery, 21% of these patients had severe coexisting illness. The study population was very heterogeneous and clinical presentation very polymorphic; infections became clinically apparent through sepsis, prosthetic malfunction, or a delay in consolidation. The diagnosis was highly dependent on the quality of the samples taken and the methodology used by the microbiology laboratory to isolate this bacterium. Culture time was long, on average 11.4 days. Treatment involved a combination of antibiotic treatments (67% of cases) and ablation of the material (83% of cases). Although P. acnes is considered to be weakly pathogenic, this bacterium may be responsible for infections in patients with implanted orthopaedic material. Ablation of the arthroplastic or osteosynthetic material is necessary in the majority of cases.
Insights
Propionibacterium acnes can cause serious orthopaedic implant infections. Surgical removal of infected material is often necessary for successful treatment, even though P. acnes is considered weakly pathogenic.
Area of Science:
- Orthopaedic Surgery
- Infectious Diseases
- Clinical Microbiology
Background:
- Propionibacterium acnes (P. acnes) is increasingly recognized as a pathogen in orthopaedic implant infections.
- These infections can present with diverse clinical manifestations, including sepsis, prosthetic malfunction, and delayed bone healing.
Purpose of the Study:
- To summarize the clinical characteristics, diagnosis, and management of orthopaedic implant infections caused by P. acnes.
- To highlight the diagnostic challenges and treatment outcomes associated with P. acnes implant infections.
Main Methods:
- Retrospective case series analysis of 52 patients with P. acnes orthopaedic implant infections.
- Review of patient demographics, clinical presentations, diagnostic methods, and treatment strategies.
- Microbiological analysis focusing on isolation and identification of P. acnes.
Main Results:
- The study included 52 patients (37 males, 15 females; mean age 51.8 years), with 21% having severe coexisting illnesses.
- Infections presented as definite (20), probable (15), or possible (17) cases, manifesting as sepsis, prosthetic malfunction, or delayed consolidation.
- Diagnosis relied heavily on sample quality and laboratory isolation techniques, with an average culture time of 11.4 days.
- Treatment involved antibiotics (67%) and material ablation (83%).
Conclusions:
- P. acnes, despite being considered weakly pathogenic, can cause significant orthopaedic implant infections.
- Effective diagnosis requires meticulous sample collection and advanced microbiological techniques.
- Ablation of the infected orthopaedic material is frequently essential for successful treatment outcomes.
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