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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
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Risk Factors for Discordance Between Synovial Fluid Culture and Intraoperative Cultures in Revision Arthroplasties:

Karsten D Ottink1,2, Flaminia Olearo3, Danguole Vaznaisiene4

  • 1Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, the University of Groningen, Groningen, the Netherlands.

JB & JS Open Access
|April 13, 2026
PubMed
Abstract

Insights

Discordance between preoperative and intraoperative cultures in periprosthetic joint infection (PJI) revision surgery is high at 36%. Factors like center, sinus tracts, and hip joint influence reliability, impacting treatment strategies.

Area of Science:

  • Orthopedic Surgery
  • Infectious Diseases
  • Microbiology

Background:

  • Accurate microorganism identification is crucial for periprosthetic joint infection (PJI) treatment.
  • Preoperative synovial fluid culture (p-SFC) and intraoperative cultures are used for diagnosis.
  • Literature reports variable concordance between p-SFC and intraoperative cultures.

Purpose of the Study:

  • To determine the incidence of discordance between p-SFC and intraoperative cultures in PJI revision arthroplasty.
  • To identify risk factors associated with this discordance.

Main Methods:

  • International multicenter retrospective observational cohort study.
  • Inclusion of patients undergoing septic total revision arthroplasty (January 2020 - January 2024).
  • Analysis of discordance rates and associated risk factors.

Main Results:

  • Overall discordance rate was 36% (n=647).
  • Significant risk factors for discordance included center-specific effects (OR 4.22), presence of a sinus tract (OR 1.80), and hip joint involvement (OR 1.61).

Conclusions:

  • Discordance between preoperative and intraoperative cultures in PJI revision is substantial.
  • Reliability is reduced in hip arthroplasty cases and those with sinus tracts.
  • Center-specific protocols may influence culture concordance.

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