Currently, despite a thorough diagnostic work up, around ten percent of the presumed aseptic revisions turn out to have unexpected positive cultures during the revision procedure. The purpose of this study was to evaluate the negative predictive value (ruling out) of the automated multiplex PCR Unyvero i60 implant and tissue infection (ITI) cartridge (U-ITI) system for the detection of microorganisms in synovial fluid obtained intraoperatively. A prospective study was conducted with 200 patients undergoing a one-stage knee or hip revision. In all patients six intraoperative tissue cultures were taken and a sample of synovial fluid which was analyzed as a culture and with the multiplex PCR U-ITI system. The primary outcome measure was the negative predictive value (NPV) of the multiplex PCR U-ITI system compared to the intraoperative tissue cultures to reliable rule out an infection.Aim
Methods
Prosthetic Joint Infection (PJI) remains one of the leading cause for revision arthroplasty.1,2 Early recognition and appropriate initial treatment of early PJI with debridement, antibiotics and implant retention (DAIR) can eradicate infection on first attempt and prevent implant failure. We evaluated the outcome after one year of patients who were treated for an early PJI after primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) with DAIR. Furthermore, we determined preoperative infection markers, microbiology, and treatment factors related to treatment failure after DAIR procedure. A retrospective cohort study was assembled with 91 patients undergoing DAIR after primary TKA or THP with a high suspicion of an early PJI. For all patients intraoperative cultures were obtained. Records were reviewed for demographic details, preoperative laboratory results, microbiological data, given treatment and postoperative follow-up. The primary outcome measure was infection-free implant survival at one year. Repeated DAIR was not considered as treatment failure.Aim
Method
Despite a preoperative workup with no evidence to suspect a prosthetic joint infection (PJI) before revision surgery, routinely obtained intraoperative cultures still can be unexpectedly positive. The purpose of this study was (1) to assess the incidence of unexpected positive intraoperative cultures in presumed aseptic knee and hip revisions and (2) to determine whether a difference exists between the infection-free implant survival rate of patients with and without unexpected positive intraoperative cultures. We selected patients who underwent a one-stage revision total knee arthroplasty (TKA) or total hip arthroplasty (THA) for different reasons. Three or more separate intraoperative cultures were obtained during each procedure. A negative result was defined as less than two positive cultures with the same microorganism. An unsuspected PJI was defined as having two or more positive cultures with the same microorganism. Patients’ medical records were reviewed to collect demographics, preoperative laboratory results, culture results, and the occurrence of infection during follow-up.Aim
Method
