Multiple cultures and extended incubation for hip and knee arthroplasty revision: impact on clinical care

Area of Science:

• Orthopedic Surgery
• Infectious Disease
• Microbiology

Background:

• Prosthetic joint infections (PJIs) are a significant complication of hip and knee arthroplasty.
• Accurate microbiological diagnosis is crucial for effective PJI management.
• Current protocols for intra-operative tissue sampling may be insufficient.

Purpose of the Study:

• To assess the impact of a new protocol requiring 5 or more intra-operative tissue biopsies on patient care in revision arthroplasty.
• To compare the diagnostic yield and treatment changes resulting from the new protocol versus the standard of care.

Main Methods:

• Retrospective chart review of 73 patients undergoing 77 revision arthroplasty procedures.
• Comparison of outcomes between a protocol using 5+ intra-operative cultures and a prior standard of 1 culture.
• Analysis of changes in microbiological diagnosis and antibiotic treatment.

Main Results:

• The new protocol changed microbiological diagnosis in 34% (26/77 cases) and antibiotic treatment in 30% (23/77 cases).
• The protocol demonstrated a 95% predictive value for joint sterility in culture-negative cases.
• A significant impact on patient care was observed, suggesting 1-2 cultures are insufficient.

Conclusions:

• A protocol of obtaining 5 or more intra-operative tissue cultures significantly alters patient care for revision arthroplasty.
• This approach improves microbiological diagnosis and guides appropriate antibiotic selection.
• Surgeons and institutions should consider adopting this protocol as a minimum standard for PJI management.