Unexpected positive cultures in conversion hip and knee arthroplasty.
Conversion Arthroplasty
Positive Culture
Total Knee arthroplasty
Total hip arthroplasty
Journal
International orthopaedics
ISSN: 1432-5195
Titre abrégé: Int Orthop
Pays: Germany
ID NLM: 7705431
Informations de publication
Date de publication:
01 Oct 2024
01 Oct 2024
Historique:
received:
28
08
2024
accepted:
21
09
2024
medline:
2
10
2024
pubmed:
2
10
2024
entrez:
1
10
2024
Statut:
aheadofprint
Résumé
Total hip and knee arthroplasty in patients with previous history of periarticular surgery, such as osteosynthesis, can be surprisingly complex. This type of procedure is known as conversion arthroplasty (cTHA or cTKA) and has a higher risk of complications. The rates of unexpected positive cultures (UPC) and the risk of periprosthetic joint infection (PJI) compared to primary arthroplasty is unclear. The main purpose of this study was to evaluate rates of Unexpected Positive Cultures (UPC) in a series of conversion arthroplasty patients. The main questions to answer are: 1. Are the patients with conversion arthroplasties more susceptible to UPC than other causes of revision arthroplasties? 2. Are the conversion patients with UPC more susceptible to developing PJI? This was a retrospective review of patients submitted to cTHA and cTKA from January 2012 to September 2018. Patients with history of previous infection or with missing intraoperative cultures were excluded. The UPC was defined as a single positive culture obtained during a procedure previously considered aseptic and PJI was defined according to the 2018 ICM criteria. After excluding 141 cases, 205 patients were analyzed, 160 hips and 45 knees. Nine (4.4%) UPC were identified, five (3.1%) in the hip group and four (8,9%) in the knee group. Staphylococcal species were the most common isolated bacteria (n = 7, 77.7%). During the study period, four (1,9%) patients were diagnosed with PJI. Only one case had an UPC and a different germ was identified during revision arthroplasty workup. While UPC are more prevalent in conversion knee arthroplasties compared to conversion hip arthroplasties, the rates are similar to those observed in revision arthroplasty for other indications. Importantly, the presence of a UPC in conversion arthroplasty does not appear to elevate the risk of subsequent periprosthetic joint infection, provided a thorough PJI workup has been conducted preoperatively. Therefore, in such cases, UPCs may be safely disregarded.
Identifiants
pubmed: 39354162
doi: 10.1007/s00264-024-06341-y
pii: 10.1007/s00264-024-06341-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
© 2024. The Author(s) under exclusive licence to SICOT aisbl.
Références
Chin G, Wright DJ, Snir N, Schwarzkopf R (2016) Primary vs conversion total hip arthroplasty: a cost analysis. J Arthroplasty 31(2):362–367. https://doi.org/10.1016/j.arth.2015.08.014
doi: 10.1016/j.arth.2015.08.014
pubmed: 26387923
Pui CM, Bostrom MP, Westrich GH, Valle CJD, Macaulay W, Mont MA et al (2013) Increased complication rate following conversion total hip arthroplasty after cephalomedullary fixation for intertrochanteric hip fractures: a multi-center study. J Arthroplasty 28(8 Suppl):45–47. https://doi.org/10.1016/j.arth.2013.04.048
doi: 10.1016/j.arth.2013.04.048
pubmed: 23891060
Ramamurti P, Fassihi SC, Stake S, Stadecker M, Whiting Z, Thakkar SC, et al (2021) Conversion total knee arthroplasty. JBJS Rev 9(9). https://doi.org/10.2106/JBJS.RVW.20.00198
La Camera F, de Matteo V, Di Maio M, Verrazzo R, Grappiolo G, Loppini M (2023) Clinical outcomes and complication rate after single-stage hardware removal and total hip arthroplasty: a matched-pair controlled study. J Clin Med 12(4):1666
doi: 10.3390/jcm12041666
pubmed: 36836201
pmcid: 9958733
Sloan M, Lee GC (2021) Is conversion TKA a primary or revision? Clinical course and complication risks approximating revision TKA rather than primary TKA. J Arthroplasty 36(8):2685-2690.e1
doi: 10.1016/j.arth.2021.03.034
pubmed: 33824045
Quan T, Wang KY, Gu A, Gioia C, Malahias MA, Stoll WT et al (2021) Conversion total knee arthroplasty: a case complexity between primary and revision total knee arthroplasty. Knee 31:180–187
doi: 10.1016/j.knee.2021.06.008
pubmed: 34256348
Cichos KH, Detweiler M, Parvizi J, McGwin G, Heatherly AR, Ghanem ES (2022) The fate of positive intraoperative cultures following conversion total hip arthroplasty. Hip Int 32(1):17–24
doi: 10.1177/1120700020936628
pubmed: 32573261
Frisch NB, Keating TC, Calkins TE, Culvern CN, Della Valle CJ (2020) Conversion total knee arthroplasty: Prior fracture or osteotomy around the knee leads to increased resource utilization. J Arthroplasty 35(12):3563–3568
doi: 10.1016/j.arth.2020.06.050
pubmed: 32665156
Schwarzkopf R, Chin G, Kim K, Murphy D, Chen AF (2017) Do conversion total hip arthroplasty yield comparable results to primary total hip arthroplasty? J Arthroplasty 32(3):862–871
doi: 10.1016/j.arth.2016.08.036
pubmed: 27687806
Denyer S, Eikani C, Bujnowski D, Farooq H (2023) Cost analysis of conversion total knee arthroplasty. J Bone Joint Surg 105(6):462–467
doi: 10.2106/JBJS.22.01184
pubmed: 36727914
Madariaga S, Vargas-Reverón C, Tornero E, Alías A, Capurro B, Combalia A et al (2021) Outcomes of hip arthroplasty with concomitant hardware removal: influence of the type of implant retrieved and impact of positive intraoperative cultures. Arch Orthop Trauma Surg 141(2):333–339
doi: 10.1007/s00402-020-03692-0
pubmed: 33241448
Ng MK, Kobryn A, Golub I, Piuzzi NS, Wong CHJ, Jones L et al (2023) Increasing trend toward joint-preserving procedures for hip osteonecrosis in the United States from 2010 to 2019. Arthroplasty. 5(1):23. https://doi.org/10.1186/s42836-023-00176-5
doi: 10.1186/s42836-023-00176-5
pubmed: 37122010
pmcid: 10150515
Abdel MP, Akgün D, Akin G, Akinola B, Alencar P, Amanatullah DF et al (2019) Hip and knee section, diagnosis, pathogen isolation, culture: proceedings of international consensus on orthopedic infections. J Arthroplasty 34:361–7
doi: 10.1016/j.arth.2018.09.020
Klatte TO, Meinicke R, O’Loughlin P, Rueger JM, Gehrke T, Kendoff D (2013) Incidence of bacterial contamination in primary tha and combined hardware removal: analysis of preoperative aspiration and intraoperative biopsies. J Arthroplasty 28(9):1677–1680
doi: 10.1016/j.arth.2013.02.017
pubmed: 23523208
Smith EJ, Heng M, Bedair HS, Melnic CM (2020) Total knee arthroplasty following intramedullary tibial nailing. Knee Surg Relat Res 32:1–5
doi: 10.1186/s43019-020-00055-2
Gittings DJ, Courtney PM, Ashley BS, Hesketh PJ, Donegan DJ, Sheth NP (2017) Diagnosing Infection in Patients Undergoing Conversion of Prior Internal Fixation to Total Hip Arthroplasty. J Arthroplasty 32(1):241–245
doi: 10.1016/j.arth.2016.06.047
pubmed: 27503694
Kamath AF, Ong KL, Lau E, Chan V, Vail TP, Rubash HE et al (2015) Quantifying the Burden of Revision Total Joint Arthroplasty for Periprosthetic Infection. J Arthroplasty 30(9):1492–1497
doi: 10.1016/j.arth.2015.03.035
pubmed: 25865815
Ribau A, Ekhtiari S, Budin M, Zanna L, FatihDasci M, Gehrke T et al (2023) Unexpected positive cultures in patients who have a history of septic revision in the same joint. J Arthroplasty 2023(38):1141–1144
doi: 10.1016/j.arth.2023.02.078
Shohat N, Bauer T, Buttaro M, Budhiparama N, Cashman J, Della Valle CJ, Zimmerli W (2019) Hip and knee section, what is the definition of a periprosthetic joint infection of the knee and the hip? can the same criteria be used for both joints?: proceedings of international consensus on orthopedic infections. J Arthroplasty 34:S325–S327
doi: 10.1016/j.arth.2018.09.045
pubmed: 30343971
Purudappa PP, Sharma OP, Priyavadana S, Sambandam S, Villafuerte JA (2020) Unexpected positive intraoperative cultures in revision Hip and knee arthroplasty- A review of the literature. J Orthop 17:1–6
doi: 10.1016/j.jor.2019.06.028
pubmed: 31879464
Goh GS, Tarabichi S, Clarkson SJ, Zanna L, Citak M, Parvizi J (2022) Positive cultures can be safely ignored in revision arthroplasty patients that do not meet the 2018 international consensus meeting criteria. J Arthroplasty 37:2257–2261
doi: 10.1016/j.arth.2022.05.015
pubmed: 35569707
Weber M, Berry DJ, Harmsen WS (1998) Total hip arthroplasty after operative treatment of an acetabular fracture*. J Bone Joint Surg 80:1295–1305
doi: 10.2106/00004623-199809000-00008
pubmed: 9759814
Ranawat A, Zelken J, Helfet D, Buly R (2009) Total hip arthroplasty for posttraumatic arthritis after acetabular fracture. J Arthroplasty 24:759–767
doi: 10.1016/j.arth.2008.04.004
pubmed: 18534534
Rezaie AA, Blevins K, Kuo FC, Manrique J, Restrepo C, Parvizi J (2020) Total hip arthroplasty after prior acetabular fracture: infection is a real concern. J Arthroplasty 35:2619–2623. https://doi.org/10.1016/j.arth.2020.03.018
doi: 10.1016/j.arth.2020.03.018
Phillips JE, Crane TP, Noy M, Elliott TSJ, Grimer RJ (2006) The incidence of deep prosthetic infections in a specialist orthopaedic hospital: a 15-year prospective survey. J Bone Joint Surg Br 88:943–951. https://doi.org/10.1302/0301-620X.88B7.17732
doi: 10.1302/0301-620X.88B7.17732
pubmed: 16799001
Willis-Owen CA, Konyves A, Martin DK (2010) Factors affecting the incidence of infection in hip and knee replacement: an analysis of 5277 cases. J Bone Joint Surg Br 92:1128–1133. https://doi.org/10.1302/0301-620X.92B8.24628
doi: 10.1302/0301-620X.92B8.24628
pubmed: 20675759
Anis HK, Ramanathan D, Sodhi N, Klika AK, Piuzzi NS, Mont MA, Barsoum WK (2019) Postoperative infection in cementless and cemented total knee arthroplasty: a propensity score matched analysis. J Knee Surg 32:1058–1062. https://doi.org/10.1055/s-0039-1693132
doi: 10.1055/s-0039-1693132
pubmed: 30754069