Guillaume Renard1,2, Jean-Michel Laffosse1, Meagan Tibbo3, Thibault Lucena1, Etienne Cavaignac1, Jean-Louis Rouvillain2, Philippe Chiron1, Mathieu Severyns4, Nicolas Reina1. 1. ILM Institut Locomoteur, Hôpital Pierre-Paul-Riquet, CHU de Toulouse, 31059, Toulouse, France. 2. Département de Chirurgie Orthopédique, Hôpital Pierre Zobda-Quitman, CHU de Martinique, 97261, Fort-de-France, France. 3. Department of Orthopedic Surgery, Mayo Clinic, 200 First Street S.W., Rochester, MN, 55905, USA. 4. Département de Chirurgie Orthopédique, Hôpital Pierre Zobda-Quitman, CHU de Martinique, 97261, Fort-de-France, France. mathieu.severyns@hotmail.fr.
Abstract
PURPOSE: There is no consensus regarding systematic screening for infection in aseptic revision total hip arthroplasty (THA). The rationale for systematic intra-operative samples is to increase the sensitivity of latent infections detection, which may require specific treatment. However, the incidence of occult infection in revision THAs is not precisely known. As such, the aim of the study was to evaluate the incidence of occult infection in presumed aseptic revision THAs and identify associated risk factors. METHOD: Bacteriological samples from 523 aseptic THA revisions performed for five years were analyzed. Revisions performed for periprosthetic joint infection (PJI) or clinical suspicion of PJI were excluded. Microbiological cultures were performed using tissue samples in 505 cases (97%), synovial fluid in blood culture vials in 158 (30%), and in dry tubes in 263 (50%). Implants were sent for sonication in 12 cases (2.6%). The mean number of microbiological samples per patient was 3.6 (range, 1-15). Histology samples were collected for 300 patients (57%). RESULTS: The incidence of occult infection was 7% (36 cases) and contamination 8% (42 cases). Among occult infections, the primary reasons for revision were dislocation (42%), aseptic loosening (25%), fracture (19%), and others (14%). The infection rate in the dislocation group was significantly higher than that of other reasons for revision (p < 0.001). Among the patients determined with PJI, the revision THA was performed less than a year after primary in 19 (53%). CONCLUSION: The incidence of occult PJI justifies systematic intraoperative sampling. A short time between primary arthroplasty and revision or an early postoperative dislocation is a factor to suspect infections.
PURPOSE: There is no consensus regarding systematic screening for infection in aseptic revision total hip arthroplasty (THA). The rationale for systematic intra-operative samples is to increase the sensitivity of latent infections detection, which may require specific treatment. However, the incidence of occult infection in revision THAs is not precisely known. As such, the aim of the study was to evaluate the incidence of occult infection in presumed aseptic revision THAs and identify associated risk factors. METHOD: Bacteriological samples from 523 aseptic THA revisions performed for five years were analyzed. Revisions performed for periprosthetic joint infection (PJI) or clinical suspicion of PJI were excluded. Microbiological cultures were performed using tissue samples in 505 cases (97%), synovial fluid in blood culture vials in 158 (30%), and in dry tubes in 263 (50%). Implants were sent for sonication in 12 cases (2.6%). The mean number of microbiological samples per patient was 3.6 (range, 1-15). Histology samples were collected for 300 patients (57%). RESULTS: The incidence of occult infection was 7% (36 cases) and contamination 8% (42 cases). Among occult infections, the primary reasons for revision were dislocation (42%), aseptic loosening (25%), fracture (19%), and others (14%). The infection rate in the dislocation group was significantly higher than that of other reasons for revision (p < 0.001). Among the patients determined with PJI, the revision THA was performed less than a year after primary in 19 (53%). CONCLUSION: The incidence of occult PJI justifies systematic intraoperative sampling. A short time between primary arthroplasty and revision or an early postoperative dislocation is a factor to suspect infections.
Entities:
Keywords:
Aseptic revision arthroplasty; Hip dislocation; Intra–operative culture; Periprosthetic joint infection; Revision total hip arthroplasty
Authors: Javad Parvizi; Benjamin Zmistowski; Elie F Berbari; Thomas W Bauer; Bryan D Springer; Craig J Della Valle; Kevin L Garvin; Michael A Mont; Montri D Wongworawat; Charalampos G Zalavras Journal: Clin Orthop Relat Res Date: 2011-11 Impact factor: 4.176
Authors: Anas Saleh; Albair Guirguis; Alison K Klika; Lucileia Johnson; Carlos A Higuera; Wael K Barsoum Journal: J Arthroplasty Date: 2014-07-16 Impact factor: 4.757