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Updated: Nov 2, 2025
Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Microbiology of hip and knee periprosthetic joint infections: a database study
Don Bambino Geno Tai1, Robin Patel2, Matthew P Abdel3
1Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Objectives:
Knowledge of the microbiological aetiology of periprosthetic joint infection (PJI) is essential to its management. Contemporary literature from the United States on this topic is lacking. This study aimed to identify the most common microorganisms associated with types of arthroplasty, the timing of infection, and clues to polymicrobial infection.
Methods:
We performed an analytical cross-sectional study of patients 18 years of age or older with hip or knee PJI diagnosed at our institution between 2010 and 2019. PJI was defined using the criteria adapted from those of the Musculoskeletal Infection Society. Cases included PJI associated with primary or revision arthroplasty and arthroplasty performed at our institution or elsewhere.
Results:
A total of 2067 episodes of PJI in 1651 patients were included. Monomicrobial infections represented 70% of episodes (n = 1448), with 25% being polymicrobial (n = 508) and the rest (5%, n = 111) culture-negative. The most common group causing PJI was coagulase-negative Staphylococcus species (other than S. ludgunensis) (37%, n = 761). The distribution of most common organisms was similar regardless of arthroplasty type. The S. aureus complex, Gram-negative bacteria, and anaerobic bacteria (other than Cutibacterium species) were more likely to be isolated than other organisms in the first year following index arthroplasty (OR 1.7, 95%CI 1.4-2.2; OR 1.5, 95%CI 1.1-2.0; and OR 1.5, 95%CI 1.0-2.2, respectively). The proportion of culture-negative PJIs was higher in primary than revision arthroplasty (6.5% versus 3%, p 0.0005). The presence of a sinus tract increased the probability of the isolation of more than one microorganism by almost three-fold (OR 2.6, 95%CI 2.0-3.3).
Conclusions:
Joint age, presence of a sinus tract, and revision arthroplasties influenced PJI microbiology.
Insights
This study identified common causes of periprosthetic joint infection (PJI), finding coagulase-negative staphylococci most frequent. Factors like sinus tracts and revision surgery impact PJI microbiology, crucial for effective treatment.
Area of Science:
- Orthopedics
- Infectious Diseases
- Microbiology
Background:
- Periprosthetic joint infection (PJI) is a significant complication of arthroplasty.
- Understanding the microbiological etiology of PJI is critical for effective management.
- Contemporary data on PJI microbiology in the United States is limited.
Purpose of the Study:
- To identify common microorganisms causing hip and knee PJI.
- To analyze the relationship between microbial etiology and arthroplasty type.
- To investigate factors influencing the timing and polymicrobial nature of PJI.
Main Methods:
- Analytical cross-sectional study of patients with hip or knee PJI (2010-2019).
- PJI diagnosis based on adapted Musculoskeletal Infection Society criteria.
- Inclusion of primary/revision and in-house/elsewhere arthroplasty cases.
Main Results:
- Coagulase-negative Staphylococcus species were the most common cause of PJI (37%).
- The S. aureus complex, Gram-negative, and anaerobic bacteria were more prevalent in early infections.
- Sinus tract presence significantly increased the likelihood of polymicrobial infection (OR 2.6).
Conclusions:
- Arthroplasty age, sinus tract presence, and revision status are key determinants of PJI microbiology.
- Monomicrobial infections were most common (70%), but polymicrobial infections occurred in 25% of cases.
- Culture-negative PJIs were more frequent in primary arthroplasties.
