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Updated: Nov 16, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Analysis of Culture Positive First and Second Stage Procedures in Periprosthetic Knee and Hip Joint Infections
Bernhard J H Frank1, Alexander Aichmair2, Sebastian Simon2
1Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Vienna-Speising, Vienna, Austria.
Background:
A positive microbiological result at reimplantation may lead to a failed 2-stage revision arthroplasty in the treatment of periprosthetic joint infections. Little is known about changes in microbiological spectrum and resistance pattern between culture positive first and second stage procedures in revision knee and hip arthroplasty.
Methods:
Between January 2011 and December 2019, we performed 327 two-stage revision arthroplasties on 312 patients. There were 37 of 312 (11.9%) patients (20 hips/17 knees) who had a positive microbiological culture during the first and second stage procedure. We analyzed the microbiological spectrum, antimicrobial resistance pattern, and clinical outcome of culture positive first and second stage procedures as well as subsequent re-revisions.
Results:
Re-revision was necessary in 40.5% (15/37) of patients with culture positive first and second stage procedure at a median follow-up of 3.5 years. We found microbiological changes in 83.8% (31/37) of patients between the first and second stage and in 88.9% (8/9) between the second stage and subsequent culture positive re-revision. Polymicrobial infections were found in 21.6% (8/37) of first and in 16.2% (6/37) of second stage procedures. In 27% (10/37) of patients, microorganisms persisted between the first and second stage procedure. The antimicrobial resistance pattern changed in 60% of persistent microorganisms between the first and second stage procedure.
Conclusion:
Changes in microbiological spectrum and resistance pattern are common between culture positive first and second stage procedures as well as subsequent re-revisions. This has to be considered in the antimicrobial treatment of periprosthetic joint infections.
Insights
Microbiological changes are common in two-stage revision arthroplasty for periprosthetic joint infections. These shifts in pathogens and resistance patterns necessitate careful consideration during antimicrobial treatment for improved patient outcomes.
Area of Science:
- Orthopedic Surgery
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infections (PJIs) pose a significant challenge in revision arthroplasty.
- Positive microbiological results during two-stage revision arthroplasty can indicate potential failure.
- Limited data exists on dynamic changes in microbial profiles during multi-stage PJI treatment.
Purpose of the Study:
- To investigate the microbiological spectrum and antimicrobial resistance patterns in culture-positive first and second stage revision arthroplasties.
- To analyze changes in these patterns between sequential procedures and subsequent re-revisions.
- To evaluate the clinical impact of these microbiological dynamics on treatment outcomes.
Main Methods:
- Retrospective analysis of 327 two-stage revision arthroplasties performed between 2011 and 2019.
- Identification and analysis of microbiological cultures from first and second stage procedures in 37 patients with positive results.
- Assessment of microbial spectrum, resistance patterns, and subsequent re-revision rates.
Main Results:
- A high rate of microbiological changes (83.8%) was observed between the first and second stages.
- Significant shifts in antimicrobial resistance patterns occurred in 60% of persistent infections.
- Re-revision was required in 40.5% of patients with positive cultures across stages, highlighting treatment complexity.
Conclusions:
- Dynamic changes in the microbiological landscape are frequent in two-stage revision arthroplasty for PJI.
- Antimicrobial stewardship must adapt to evolving resistance patterns for effective PJI management.
- Understanding these microbial shifts is crucial for optimizing treatment strategies and improving success rates.
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