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Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.

Publication ,  Journal Article
Wu, CJ; Leal, J; Seyler, TM; Jiranek, WA; Wellman, SS; Bolognesi, MP; Ryan, SP
Published in: J Arthroplasty
October 2024

BACKGROUND: The purpose of this study was to evaluate the management and outcomes of aseptic revision total knee arthroplasty (arTKA) with unsuspected positive cultures (UPCs) compared to those with sterile cultures. METHODS: The institutional database at a single tertiary center was retrospectively reviewed for arTKA from January 2013 to October 2023. Patients who met Musculoskeletal Infection Society criteria for periprosthetic joint infection (PJI) based on available preoperative infectious workup, received antibiotic spacers, or did not have at least 1 year of follow-up were excluded. Patients were stratified based on intraoperative cultures into 4 cohorts: sterile cultures, 1 UPC, ≥ 2 UPCs with different organisms, and ≥ 2 UPCs with the same organism. Univariable analyses were used to compare these groups. Kaplan-Meier survivorship analysis assessed infection-free survival at 5 years, and Cox proportional hazards regressions were used to evaluate factors that influence infection-free survival. A total of 691 arTKAs at a mean follow-up of 4.2 years were included in the study. Of these, 49 (7.1%) had 1 UPC with a new organism, 10 (1.4%) had ≥2 UPCs of the same organism, and 2 (0.2%) had ≥2 UPCs with different organisms. RESULTS: Postoperative antibiotics were prescribed to 114 (16.5%) patients-13 (26.5%) with 1 UPC, 6 (60.0%) with ≥2 UPCs of the same organism, and 0 (0.0%) of patients who had ≥2 UPCs of different organisms. There were no differences in infection-free survival at 5 years between patients who had sterile cultures and 1 UPC (96 versus 89%; P = .39) nor between sterile cultures and ≥2 UPCs of different organisms (96 versus 100%; P < .72). However, patients who had ≥2 UPCs of the same organism had significantly worse infection-free survival at 5 years compared to patients who had sterile cultures (58 versus 96%; P < .001). Cox proportional hazards regression suggested that when adjusting for covariates, an American Society of Anesthesiologists classification of ≥3 (hazard ratio [HR] = 3.1; P = .007), ≥2 UPCs of the same organism (HR = 11.0; P < .001), 1 UPC (HR = 4.2; P = .018), and arTKA with hinge constructs (HR = 4.1; P = .008) were associated with increased risk of rerevision for PJI. CONCLUSIONS: Patients who had 1 UPC or ≥2 UPCs with different organisms had similar infection-free survival at 5 years as patients who had sterile cultures. However, patients who had ≥2 UPCs of the same organism had significantly worse infection-free survival at 5 years. Overall, 1 UPC or ≥2 UPCs of the same organism at the time of arTKA may suggest the patient is at higher risk of rerevision for PJI. More studies are needed to determine what interventions can be implemented to mitigate this risk.

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Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

October 2024

Volume

39

Issue

10

Start / End Page

2581 / 2590

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Reoperation
  • Prosthesis-Related Infections
  • Prevalence
  • Orthopedics
  • Middle Aged
  • Male
  • Knee Prosthesis
  • Humans
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Wu, C. J., Leal, J., Seyler, T. M., Jiranek, W. A., Wellman, S. S., Bolognesi, M. P., & Ryan, S. P. (2024). Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship. J Arthroplasty, 39(10), 2581–2590. https://doi.org/10.1016/j.arth.2024.06.007
Wu, Christine J., Justin Leal, Thorsten M. Seyler, William A. Jiranek, Samuel S. Wellman, Michael P. Bolognesi, and Sean P. Ryan. “Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.J Arthroplasty 39, no. 10 (October 2024): 2581–90. https://doi.org/10.1016/j.arth.2024.06.007.
Wu CJ, Leal J, Seyler TM, Jiranek WA, Wellman SS, Bolognesi MP, et al. Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship. J Arthroplasty. 2024 Oct;39(10):2581–90.
Wu, Christine J., et al. “Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship.J Arthroplasty, vol. 39, no. 10, Oct. 2024, pp. 2581–90. Pubmed, doi:10.1016/j.arth.2024.06.007.
Wu CJ, Leal J, Seyler TM, Jiranek WA, Wellman SS, Bolognesi MP, Ryan SP. Unsuspected Positive Intraoperative Cultures in Aseptic Revision Knee Arthroplasty: Prevalence, Management, and Infection-Free Survivorship. J Arthroplasty. 2024 Oct;39(10):2581–2590.
Journal cover image

Published In

J Arthroplasty

DOI

EISSN

1532-8406

Publication Date

October 2024

Volume

39

Issue

10

Start / End Page

2581 / 2590

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Reoperation
  • Prosthesis-Related Infections
  • Prevalence
  • Orthopedics
  • Middle Aged
  • Male
  • Knee Prosthesis
  • Humans
  • Female