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Updated: Mar 26, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Analysis of causative microorganism in 248 primary hip arthroplasties revised for infection: a study using the NJR
Richard J Holleyman1,2, Paul N Baker1,3, Andre Charlett4
1Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne - UK.
Introduction:
This study aimed to describe the epidemiology of the causative organism in a series of primary hip arthroplasties revised for a diagnosis of periprosthetic joint infection (PJI) in England and Wales.
Methods:
Patient data from the National Joint Registry (NJR) was linked to microbiology data held by Public Health England (PHE) which identified a series of 248 primary hip arthroplasties revised for PJI between 2003 and 2014. Definitive cultures, isolated at time of revision surgery, were available for all cases. Total hip arthroplasty (n = 239, 96%) and hip resurfacing (n = 5, 2%) were the most commonly performed primary procedures. A two-stage revision was the most common operative management (n = 174, 70%).
Results:
202 (81%) cases were infected with a single genus microorganism and the most commonly implicated genus was Staphylococcus species (70% of all single genus infections). Staphylococcus species were also the most commonly identified microorganism in mixed genus infections (74% of patient's cultures). There was a significant difference in microorganism distribution when comparing uncemented vs cement implant fixation, with a higher incidence of Gram-negative infection observed in the uncemented group (p = 0.048, Chi-square).
Conclusions:
Both prophylactic and therapeutic antibiotic regimes should be focused on targeting Staphylococci.
Insights
Staphylococcus species are the most common cause of periprosthetic joint infection (PJI) following hip arthroplasty. Antibiotic strategies for preventing and treating hip PJI should prioritize targeting Staphylococci.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Epidemiology
Background:
- Periprosthetic joint infection (PJI) is a significant complication following hip arthroplasty.
- Understanding the epidemiology of causative organisms is crucial for effective management.
Purpose of the Study:
- To describe the epidemiology of microorganisms causing PJI in hip arthroplasty revisions in England and Wales.
- To identify the most common causative agents and their distribution patterns.
Main Methods:
- Data from the National Joint Registry (NJR) was linked with Public Health England microbiology data.
- Analysis of definitive cultures from 248 primary hip arthroplasties revised for PJI between 2003 and 2014.
- Comparison of microorganism distribution based on implant fixation methods (cemented vs. uncemented).
Main Results:
- Staphylococcus species were the most common cause of single-genus PJI (70%) and were also prevalent in mixed-genus infections (74%).
- Gram-negative infections showed a higher incidence in uncemented implants compared to cemented ones (p=0.048).
- Total hip arthroplasty was the most frequent primary procedure (96%), with two-stage revision being the commonest surgical management (70%).
Conclusions:
- Prophylactic and therapeutic antibiotic regimens should target Staphylococcus species for hip PJI.
- The findings highlight the importance of organism-specific antibiotic strategies in managing hip PJI.
- Differences in infection patterns based on implant fixation warrant further investigation.
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