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Clinical and microbiological findings in prosthetic joint replacement due to aseptic loosening
A Ribera1, L Morata2, J Moranas1
1Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain.
Objectives:
A role for microorganisms in aseptic prosthetic loosening (AL) is postulated. We analyse the microbiological and clinical findings of patients with suspected AL, and compare them with patients with chronic prosthetic joint infection (PJI).
Methods:
Prospective study (2011-2012) of patients with presumed AL. Evaluation of tissue samples (≥5; TS) at the time of surgery and sonication fluid (SF) of prosthesis.
Results:
According to positive culture in TS/SF, 89 patients were divided into: Group1: (≥2 positive-TS; n = 12); Group2: single positive-TS and concordant SF (n = 10); Group3: one positive or non-concordant TS or SF (n = 38); and Group4: cultures negative (n = 29). Positive-SF was always concordant with TS in Group 1 (75%); it was positive in 74% in Group 3. Median months (prosthesis-age: implantation to revision arthroplasty) for PJI and Group 1-4 was 21, 46, 65, 63 and 81, respectively (P < 0.001); they also had a different dynamic trend in prosthesis failure (P < 0.001).
Conclusions:
Several patients with suspected AL are misdiagnosed PJI. Results from SF correlated well with TS in Group 1, led us to consider single positive-TS as significant (Group 2) and to suggest that microorganisms were on the prosthesis (Group 3). We observed a correlation between microbiology and prosthesis-age, which supports that early loosening is more often caused by hidden PJI than late loosening.
Insights
Microorganisms may cause aseptic prosthetic loosening (AL), often misdiagnosed as prosthetic joint infection (PJI). Early loosening is frequently linked to hidden PJI, highlighting the importance of microbiological analysis in revision arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Aseptic prosthetic loosening (AL) is a common complication of joint replacement surgery.
- The role of microorganisms in AL is often postulated but challenging to confirm.
- Distinguishing between AL and chronic prosthetic joint infection (PJI) is critical for appropriate treatment.
Purpose of the Study:
- To analyze microbiological and clinical findings in patients with suspected AL.
- To compare these findings with those of patients diagnosed with PJI.
- To investigate the correlation between microbiological results and prosthesis age.
Main Methods:
- Prospective study conducted between 2011 and 2012.
- Evaluation of tissue samples (≥5) and sonication fluid from prostheses in patients with suspected AL.
- Classification of patients into four groups based on microbiological culture results.
Main Results:
- 89 patients were categorized into four groups based on positive cultures in tissue samples (TS) and sonication fluid (SF).
- Sonication fluid results correlated well with tissue samples in Group 1 (≥2 positive TS).
- Prosthesis age at revision arthroplasty differed significantly across groups, with PJI patients having the youngest prosthesis age (21 months).
Conclusions:
- A significant number of patients suspected of AL are misdiagnosed PJI.
- Microbiological findings, including single positive tissue samples, suggest the presence of microorganisms on the prosthesis.
- A correlation between microbiology and prosthesis age supports the hypothesis that early loosening is often due to occult PJI.
