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Published on: December 3, 2017
Unexpected positive cultures in patients with arthrofibrosis following total hip and total knee arthroplasty
Yuri Lara-Taranchenko1,2, Tiago Moreira2,3, N Amir Sandiford4
1Orthopaedic Surgery Department, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Pg. Vall d'Hebron 119-129, 08035, Barcelona, Spain.
Purpose:
It has been suggested that low-grade infections could be the cause of arthrofibrosis. However, this hypothesis has not been conclusively proven. The aim of this study is to assess the incidence of unexpected positive cultures (UPC) in patients undergoing revision total joint arthroplasty for a diagnosis of arthrofibrosis.
Methods:
A retrospective single-centre review was performed. All patients who underwent an aseptic revision due to histologically confirmed arthrofibrosis (based on the synovial-like interface membrane (SLIM) criteria) were included. The incidence of UPC was then calculated.
Results:
A total of 147 patients were included. Of these, 100 underwent a total knee arthroplasty (TKA) procedure and 46 a total hip arthroplasty (THA) surgery. One patient had a periprosthetic joint infection and was therefore excluded. Of the 146 included patients, 6 had confirmed UPC (4.08%). The following bacteria were identified: Anaerococcus octavius, Staphylococcus epidermidis, Enterobacter cloacae, Staphylococcus hominis, Streptococcus pluranimalium, Staphylococcus pettenkoferi.
Conclusions:
Our results suggest that the incidence of UPC in patients with arthrofibrosis is low. It is lower than that of UPC in patients that undergo a revision for other causes. There is no proven relationship between histologically confirmed arthrofibrosis following total joint arthroplasty and prosthetic joint infection.
Insights
This study found a low incidence of unexpected positive cultures in patients with arthrofibrosis undergoing revision total joint arthroplasty. The findings do not support a link between arthrofibrosis and prosthetic joint infection.
Area of Science:
- Orthopedic Surgery
- Infectious Disease
- Biomedical Research
Background:
- Arthrofibrosis following total joint arthroplasty is a challenging complication.
- The role of low-grade infections as a cause of arthrofibrosis remains debated.
- Histological confirmation of arthrofibrosis is crucial for diagnosis.
Purpose of the Study:
- To determine the incidence of unexpected positive cultures (UPC) in patients with arthrofibrosis undergoing revision total joint arthroplasty.
- To investigate the potential association between arthrofibrosis and subclinical prosthetic joint infection.
- To evaluate the diagnostic yield of intraoperative cultures in revision arthroplasty for arthrofibrosis.
Main Methods:
- Retrospective single-center review of patients with histologically confirmed arthrofibrosis (SLIM criteria).
- Inclusion of patients undergoing revision total knee arthroplasty (TKA) and total hip arthroplasty (THA).
- Calculation of the incidence of unexpected positive cultures (UPC) from intraoperative samples.
Main Results:
- 146 patients with arthrofibrosis were analyzed after excluding one with periprosthetic joint infection.
- Unexpected positive cultures (UPC) were confirmed in 6 patients (4.08%).
- Identified bacteria included Anaerococcus octavius, Staphylococcus epidermidis, Enterobacter cloacae, and others.
Conclusions:
- The incidence of UPC in arthrofibrosis patients is low, lower than in revisions for other causes.
- Current evidence does not establish a definitive relationship between arthrofibrosis and prosthetic joint infection.
- Further research may be needed to fully elucidate the etiology of arthrofibrosis.
