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General Orthopaedics

IS A POSITIVE INTRAOPERATIVE CULTURE ASSOCIATED WITH POOR RESULTS IN PRESUMED ASEPTIC REVISION OF TOTAL HIP AND KNEE ARTHROPLASTIES?

European Bone and Joint Infection Society (EBJIS) meeting, Antwerp, Belgium, September 2019.



Abstract

Aims

The purpose of this study was to evaluate the infection-free outcome of patients underwent revision of total joint arthroplasty (TJA) for presumed aseptic causes, with positive intra-operative cultures.

Patients and Methods

A retrospective cohort study was assembled with 130 patients undergoing revision knee (21 cases) or hip arthroplasty (109 cases) for presumed aseptic causes. For all patients five to seven separate intra-operative cultures were obtained and prosthesis sonication was done. Patients were diagnosed with a previously unsuspected prosthetic joint infection (PJI) if two or more cultures were

positive or a positive prosthesis sonication. Data were reviewed for demographic details, preoperative laboratory results and culture results. The endpoint was infection-free implant survival at 24 months.

Results

Patients with unsuspected PJI was 16 out of 130 (12,3%). Following revision surgery, the rate of infection-free implant survival in patients with an unsuspected PJI was 68,8% (95% confidence intervals (CI) 45,6 to 92) at two years compared

with 94,7% (95% CI 90,5 to 98,9) in patients without PJI (p = 0.001).

Conclusion

Around 12% of positive cultures can be expected after TJA aseptic revision surgery; in these cases, the rate of infection-free implant survival is lower than in cases without PJI.


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