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Unexpected positive intraoperative cultures in aseptic revision arthroplasty

Anas Saleh1, Albair Guirguis1, Alison K Klika1

  • 1Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.

The Journal of Arthroplasty
|August 16, 2014
PubMed

Insights

Unexpected positive intraoperative cultures during revision arthroplasty can indicate infection. Even without meeting strict criteria, patients may still develop periprosthetic joint infection (PJI) after surgery.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Unexpected positive intraoperative cultures (UPIC) complicate the diagnosis of periprosthetic joint infection (PJI) in revision arthroplasty.
  • Interpreting UPIC in presumed aseptic cases requires careful consideration of subsequent infection development.

Purpose of the Study:

  • To compare the incidence of subsequent PJI in patients treated with antibiotics based on institutional protocol versus those not treated.
  • To evaluate if patients met Musculoskeletal Infection Society (MSIS) criteria for PJI.

Main Methods:

  • Retrospective study design.
  • Analysis of patients undergoing revision arthroplasty with UPIC.
  • Comparison of PJI incidence based on antibiotic treatment and MSIS criteria adherence.

Main Results:

  • UPIC are not uncommon in aseptic revision arthroplasty.
  • Patients treated with antibiotics according to institutional criteria who did not meet MSIS criteria had a higher incidence of PJI (22%) compared to those who met MSIS criteria (14%).

Conclusions:

  • Periprosthetic joint infection (PJI) cannot be excluded in patients with UPIC who do not meet MSIS definition.
  • Clinical judgment and adherence to treatment protocols are crucial for managing UPIC in revision arthroplasty.
Keywords:
aseptic revision arthroplastyintraoperative culturesperiprosthetic joint infectionrevision hip arthroplastyrevision knee arthroplasty

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