Related Experiment Video
Updated: Mar 16, 2026
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Positive Culture During Reimplantation Increases the Risk of Subsequent Failure in Two-Stage Exchange Arthroplasty
Timothy L Tan1, Miguel M Gomez1, Jorge Manrique1
1Rothman Institute, Philadelphia, Pennsylvania.
Background:
It is strongly recommended that tissue and synovial fluid culture samples be obtained during reimplantation performed as part of a 2-stage exchange arthroplasty. The rate of positive cultures during reimplantation and the influence of positive cultures on subsequent outcomes, to our knowledge, are unknown. This study was designed to determine the rate of positive cultures during reimplantation and to investigate the association between positive cultures at reimplantation and subsequent outcomes.
Methods:
We retrospectively reviewed the data of 259 patients who met the Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) and who underwent both stages of 2-stage exchange arthroplasty at our institution from 1999 to 2013. Among these patients were 267 PJIs (186 knees and 81 hips); 33 (12.4%) had ≥1 positive culture result at reimplantation. Treatment failure was assessed according to the Delphi-based consensus definition. Logistic regression analysis was performed to assess the predictors of positive culture and risk factors for failure of 2-stage exchange arthroplasty.
Results:
Of the 33 cases with PJI, 15 (45.5%) had a subsequent failure of the 2-stage exchange arthroplasty compared with 49 (20.9%) of the cases that were culture-negative at reimplantation. When controlling for other variables using multivariate analyses, the risk of treatment failure was higher (odds ratio = 2.53; 95% confidence interval [CI] = 1.13 to 5.64) and reinfection occurred earlier (hazard ratio = 2.00; 95% CI = 1.05 to 3.82) for the cases with a positive culture during reimplantation. The treatment failure rate did not differ (p = 0.73) between cases with ≥2 positive cultures (36.4%) and 1 positive culture (50%).
Conclusions:
Positive intraoperative culture at the time of reimplantation, regardless of the number of positive samples, was independently associated with >2 times the risk of subsequent treatment failure and earlier reinfection. Surgeons should be aware that a positive culture at the time of reimplantation independently increases the risk of subsequent failure.
Level Of Evidence:
Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Insights
Positive intraoperative cultures during reimplantation for periprosthetic joint infection (PJI) significantly increase the risk of treatment failure and earlier reinfection after 2-stage exchange arthroplasty.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Medical Microbiology
Background:
- Two-stage exchange arthroplasty is a common treatment for periprosthetic joint infection (PJI).
- Intraoperative cultures are recommended during reimplantation, but their predictive value for outcomes is unclear.
- This study investigates the rate and impact of positive cultures during reimplantation in PJI cases.
Purpose of the Study:
- To determine the rate of positive intraoperative cultures during reimplantation in 2-stage exchange arthroplasty for PJI.
- To assess the association between positive cultures at reimplantation and subsequent treatment failure or reinfection.
Main Methods:
- Retrospective review of 259 patients with PJI undergoing 2-stage exchange arthroplasty (1999-2013).
- Analysis of 267 PJIs, identifying 33 (12.4%) with positive reimplantation cultures.
- Logistic regression used to evaluate predictors of positive cultures and risk factors for treatment failure.
Main Results:
- Cases with positive reimplantation cultures had a 45.5% failure rate versus 20.9% for culture-negative cases.
- Positive cultures independently increased treatment failure risk (OR=2.53) and earlier reinfection (HR=2.00).
- Failure rates did not significantly differ between one or multiple positive cultures.
Conclusions:
- Positive intraoperative cultures during reimplantation are a significant independent predictor of subsequent treatment failure in 2-stage exchange arthroplasty for PJI.
- Surgeons must consider positive culture results as an indicator of increased risk for poorer outcomes.
- Awareness of this association can inform clinical decision-making and patient counseling.
Related Concept Videos
01:24Tissue Transplantation
The Biology of Tissue Transplantation
The biology of tissue transplantation hinges on the Major Histocompatibility Complex (MHC) molecules. These molecules...
01:26Kidney Transplant II: Surgical Procedure