Abstract
Aim
The aim of our study was to evaluate culture-negative prosthetic joint infections in patients who were pre-operatively evaluated as aseptic failure.
Method
For the purpose of the study we included patients planed for revision surgery for presumed aseptic failure. Intraoperatively acquired samples of periprosthetic tissue and explanted prosthesis were microbiologicaly evaluated using standard microbiologic methods and sonication. If prosthetic joint infection was discovered, additional therapy was introduced.
Results
Between October 2010 and June 2016 265 cases were operated as aseptic loosenings (66 revision knee arthroplasty, 199 revision hip arthroplasty). 69 (26,0%) cases had positive sonication and negative periprosthetic tissue sample, 24 (9,1%) cases had positive tissue samples, but negative sonication, in 27 (10,2%) cases both tests were positive and in 145 (54,7%) cases all microbiologic tests were negative.
In both groups coagulase-negative staphylococci and P.acnes were most common, followed by mixed flora.
Conclusions
With the increasing number of patients requiring revision arthroplasty, a clear differentiation between aseptic failure and prosthetic joint infection is crucial for the optimal treatment. Sonication of explanted material is more successful in the isolation of pathogens compared to periprosthetic tissue cultures. Sonication of explanted prosthetic material is helpful in the detection of culture-negative prosthetic joint infections.
