A Ribera1, L Morata2, J Moranas3, J L Agulló3, J C Martínez2, Y López2, D García3, J Cabo3, S García-Ramiro2, A Soriano2, O Murillo3. 1. Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain. Electronic address: albaribera@gmail.com. 2. Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Clínic, Barcelona, Spain. 3. Infectious Diseases, Microbiology and Orthopedic Surgery Department, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain.
Abstract
OBJECTIVES: A role for microorganisms in aseptic prosthetic loosening (AL) is postulated. We analyse the microbiological and clinical findings of patients with suspected AL, and compare them with patients with chronic prosthetic joint infection (PJI). METHODS: Prospective study (2011-2012) of patients with presumed AL. Evaluation of tissue samples (≥5; TS) at the time of surgery and sonication fluid (SF) of prosthesis. RESULTS: According to positive culture in TS/SF, 89 patients were divided into: Group1: (≥2 positive-TS; n = 12); Group2: single positive-TS and concordant SF (n = 10); Group3: one positive or non-concordant TS or SF (n = 38); and Group4: cultures negative (n = 29). Positive-SF was always concordant with TS in Group 1 (75%); it was positive in 74% in Group 3. Median months (prosthesis-age: implantation to revision arthroplasty) for PJI and Group 1-4 was 21, 46, 65, 63 and 81, respectively (P < 0.001); they also had a different dynamic trend in prosthesis failure (P < 0.001). CONCLUSIONS: Several patients with suspected AL are misdiagnosed PJI. Results from SF correlated well with TS in Group 1, led us to consider single positive-TS as significant (Group 2) and to suggest that microorganisms were on the prosthesis (Group 3). We observed a correlation between microbiology and prosthesis-age, which supports that early loosening is more often caused by hidden PJI than late loosening.
OBJECTIVES: A role for microorganisms in aseptic prosthetic loosening (AL) is postulated. We analyse the microbiological and clinical findings of patients with suspected AL, and compare them with patients with chronic prosthetic joint infection (PJI). METHODS: Prospective study (2011-2012) of patients with presumed AL. Evaluation of tissue samples (≥5; TS) at the time of surgery and sonication fluid (SF) of prosthesis. RESULTS: According to positive culture in TS/SF, 89 patients were divided into: Group1: (≥2 positive-TS; n = 12); Group2: single positive-TS and concordant SF (n = 10); Group3: one positive or non-concordant TS or SF (n = 38); and Group4: cultures negative (n = 29). Positive-SF was always concordant with TS in Group 1 (75%); it was positive in 74% in Group 3. Median months (prosthesis-age: implantation to revision arthroplasty) for PJI and Group 1-4 was 21, 46, 65, 63 and 81, respectively (P < 0.001); they also had a different dynamic trend in prosthesis failure (P < 0.001). CONCLUSIONS: Several patients with suspected AL are misdiagnosed PJI. Results from SF correlated well with TS in Group 1, led us to consider single positive-TS as significant (Group 2) and to suggest that microorganisms were on the prosthesis (Group 3). We observed a correlation between microbiology and prosthesis-age, which supports that early loosening is more often caused by hidden PJI than late loosening.
Authors: Adam C Rothenberg; Alan E Wilson; John P Hayes; Michael J O'Malley; Brian A Klatt Journal: Clin Orthop Relat Res Date: 2017-07 Impact factor: 4.176
Authors: Matthew A Getzlaf; Eric A Lewallen; Hilal M Kremers; Dakota L Jones; Carolina A Bonin; Amel Dudakovic; Roman Thaler; Robert C Cohen; David G Lewallen; Andre J van Wijnen Journal: J Orthop Res Date: 2015-12-29 Impact factor: 3.494
Authors: Martin McNally; Ricardo Sousa; Marjan Wouthuyzen-Bakker; Antonia F Chen; Alex Soriano; H Charles Vogely; Martin Clauss; Carlos A Higuera; Rihard Trebše Journal: Bone Joint J Date: 2021-01 Impact factor: 5.082
Authors: Marta Fernandez-Sampedro; Carlos Salas-Venero; Concepción Fariñas-Álvarez; Manuel Sumillera; Luis Pérez-Carro; Michel Fakkas-Fernandez; Javier Gómez-Román; Luis Martínez-Martínez; María Carmen Fariñas Journal: BMC Infect Dis Date: 2015-06-18 Impact factor: 3.090
Authors: Mattia Loppini; Alessandro Pisano; Marco Di Maio; Francesco La Camera; Maddalena Casana; Guido Grappiolo Journal: Int Orthop Date: 2021-07-22 Impact factor: 3.075