Unexpected positive cultures in conversion hip and knee arthroplasty.

IF 2 3区医学 Q2 ORTHOPEDICS International Orthopaedics Pub Date : 2024-12-01 Epub Date: 2024-10-01 DOI:10.1007/s00264-024-06341-y

Tiago Moreira, Yuri Lara-Taranchenko, T David Luo, Abdullah A Alfaraj, NAmir Sandiford, Ernesto Guerra-Farfán, Thorsten Gehrke, Mustafa Citak

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Abstract

Purpose: 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?

Methods: 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.

Results: 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.

Conclusions: 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.

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转换髋关节和膝关节置换术中的意外阳性培养物。

目的：对既往接受过关节周围手术（如骨合成术）的患者进行全髋关节和膝关节置换术，其复杂程度可能令人吃惊。这类手术被称为转换关节成形术（cTHA 或 cTKA），并发症风险较高。与一级关节成形术相比，意外阳性培养（UPC）的发生率和假体周围关节感染（PJI）的风险尚不清楚。本研究的主要目的是评估一系列转换关节置换术患者的意外阳性培养（UPC）率。要回答的主要问题有1.与其他原因导致的翻修关节置换术相比，转换关节置换术患者是否更容易感染 UPC？2.患有 UPC 的翻修病人是否更容易发生 PJI？这是对 2012 年 1 月至 2018 年 9 月期间接受 cTHA 和 cTKA 的患者进行的回顾性研究。排除了既往有感染史或术中培养缺失的患者。UPC 被定义为在之前被认为是无菌的手术中获得的单次阳性培养，而 PJI 则根据 2018 年 ICM 标准进行定义。排除141例病例后，对205例患者进行了分析，其中髋关节160例，膝关节45例：共发现 9 例（4.4%）UPC，其中髋关节组 5 例（3.1%），膝关节组 4 例（8.9%）。葡萄球菌是最常见的分离细菌（n = 7，77.7%）。在研究期间，有四名患者（1.9%）被确诊为肺结核。只有一例患者感染了 UPC，在翻修关节置换术检查中发现了不同的病菌：结论：与髋关节置换术相比，UPC在膝关节置换术中更为常见，但其发生率与其他适应症的翻修关节置换术相似。重要的是，如果术前进行了全面的假体周围感染检查，那么在转换关节置换术中出现 UPC 似乎不会增加后续假体周围感染的风险。因此，在这种情况下，可以放心地忽略 UPC。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.