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Updated: Jun 23, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Positive culture rate in revision shoulder arthroplasty
James D Kelly1, E Rhett Hobgood
1California Pacific Medical Center, 2351 Clay Street, Suite 510, San Francisco, CA 94115, USA. jimkelly@sfshoulder.com
Abstract:
We recognized a trend of positive cultures taken from presumably uninfected shoulders during revision arthroplasty. Owing to the indolent nature of common shoulder pathogens such as Propionibacterium acnes, these cultures often become positive several days, even weeks, after surgery. Having concern regarding the potential importance of these positive cultures, we reviewed our revision arthroplasty population to determine the rate of positive intraoperative cultures in patients presumed to be aseptic, to characterize the isolated organisms, and to determine the subsequent development of infection. We retrospectively reviewed 27 patients (28 revisions) presumed to be uninfected between April 2005 and October 2007. Intraoperative cultures were positive in eight (29%) of the 28 revisions. Propionibacterium acnes was isolated in six. Methicillin-resistant Staphylococcus aureus was isolated in one patient and coagulase-negative Staphylococcus aureus was isolated in one patient. One-year followup was available on 24 of the 28 revisions. Two of the eight culture-positive revisions had a subsequent infection develop. Cultures taken at revision surgery for failed shoulder arthroplasty are often positive, and our findings document the importance of these positive cultures. Our data confirm previous reports isolating Propionibacterium acnes as a primary pathogen in revision shoulder arthroplasty.
Insights
Positive cultures during shoulder revision surgery are common, especially with Propionibacterium acnes. These findings highlight the importance of intraoperative cultures in detecting potential infections after shoulder arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Microbiology
Background:
- Intraoperative cultures during shoulder revision arthroplasty can yield positive results even in presumed aseptic cases.
- The indolent nature of pathogens like Propionibacterium acnes can lead to delayed culture positivity.
Purpose of the Study:
- To determine the rate of positive intraoperative cultures in patients undergoing revision shoulder arthroplasty.
- To characterize the organisms isolated from these cultures.
- To assess the subsequent development of infection in culture-positive cases.
Main Methods:
- Retrospective review of 27 patients (28 revisions) presumed to be uninfected.
- Analysis of intraoperative culture results and organism identification.
- One-year follow-up to monitor for subsequent infections.
Main Results:
- Twenty-nine percent (8/28) of revisions had positive intraoperative cultures.
- Propionibacterium acnes was the most common isolate (6/8).
- Two of the eight culture-positive revisions developed subsequent infections.
Conclusions:
- Intraoperative cultures in revision shoulder arthroplasty frequently yield positive results.
- Positive cultures, particularly those with Propionibacterium acnes, are significant predictors of subsequent infection.
- These findings underscore the clinical importance of analyzing intraoperative cultures in revision shoulder arthroplasty.