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Two-stage revision for the culture-negative infected total hip arthroplasty : A comparative study

M S Ibrahim1, H Twaij2, F S Haddad3

  • 1The Royal London, Whitechapel Road, London, E1 1BB, UK.

The Bone & Joint Journal
|January 3, 2018
PubMed
Abstract

Insights

Managing culture-negative periprosthetic joint infection (PJI) after total hip arthroplasty (THA) is challenging. This study found no significant difference in outcomes between culture-negative and culture-positive PJI patients treated with two-stage revision.

Area of Science:

  • Orthopedic surgery
  • Infectious disease
  • Arthroplasty

Background:

  • Periprosthetic joint infection (PJI) is a serious complication of total hip arthroplasty (THA).
  • While protocols exist for culture-positive PJI, management of culture-negative PJI lacks clear guidance.
  • Culture-negative PJI presents a significant challenge for surgical teams.

Purpose of the Study:

  • To compare treatment outcomes for culture-negative versus culture-positive PJI patients undergoing two-stage revision THA.
  • To evaluate the efficacy of a standardized two-stage revision approach for both PJI types.

Main Methods:

  • A comparative study of 50 culture-negative and 50 culture-positive PJI patients.
  • All patients underwent two-stage revision total hip arthroplasty for chronic infection.
  • Minimum follow-up duration was five years post-operatively.

Main Results:

  • No significant difference in treatment outcomes between culture-negative and culture-positive PJI groups.
  • Similar re-infection rates (6%) observed in both groups at five years.
  • Culture-negative PJI associated with older age, smoking, and prior antibiotic use.

Conclusions:

  • A strict, protocol-driven two-stage revision approach is effective for managing culture-negative PJI.
  • This approach yields comparable results to those for culture-positive PJI.
  • Standardizing treatment for culture-negative PJI is crucial for infection control.
Keywords:
Culture negative infectionHip arthroplastyTotal hip replacementTwo-stage revision

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