Department of Orthopedics and Trauma Surgery, Hospital Clinic of Barcelona, University of Barcelona, Barcelona, Spain.
Department of Infectious Diseases, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain.
J Arthroplasty. 2020 Jul;35(7):1912-1916. doi: 10.1016/j.arth.2020.02.025. Epub 2020 Feb 18.
Our aim is to investigate the impact of unexpected positive cultures on the outcome of partial prosthetic revisions.
Data regarding patients who underwent a partial hip or knee revision from 2003 and 2012 with the preoperative diagnosis of aseptic loosening was retrospectively reviewed. The protocol of revision included at least 3 intraoperative cultures. Failure was defined as the need for re-revision due to aseptic or septic loosening at 5 years.
A total of 99 hip and 46 knee partial revisions were included. All cases had at least 5 years of follow-up. Ninety-seven cases (66.9%) had all cultures negative, 35 (24.1%) a single positive culture and 13 (9.0%) ≥2 positive cultures for the same microorganism. The median time from primary arthroplasty to partial revision was significantly shorter for patients with ≥2 positive cultures (26 months) than in those with all cultures negative (48 months) or with a single positive culture (51 months). Partial revisions performed within the first 5 years of implantation had a higher 5-year re-revision rate. The presence of a single positive culture during the partial exchange was not associated with a higher re-revision rate (2 of 35, 5.7%) than in those with negative cultures (3 of 97, 3.1%). On the contrary, re-revision rate was significantly higher in cases with ≥2 positive cultures (3 of 13, 23.1%) than in those with negative cultures (P = .02).
Partial revisions performed within the first 5 years from implantation and ≥2 intraoperative positive cultures were associated with a higher re-revision risk at 5 years.
本研究旨在探讨意外阳性培养对部分假体翻修结局的影响。
回顾性分析了 2003 年至 2012 年期间因无菌性松动而行髋关节或膝关节部分翻修的患者资料。翻修方案包括至少 3 次术中培养。术后 5 年时因无菌性或感染性松动而需再次翻修定义为失败。
共纳入 99 例髋关节和 46 例膝关节部分翻修。所有病例均随访 5 年以上。97 例（66.9%）所有培养均为阴性，35 例（24.1%）仅 1 次培养阳性，13 例（9.0%）同一种微生物≥2 次培养阳性。与所有培养阴性（48 个月）或仅 1 次培养阳性（51 个月）的患者相比，≥2 次培养阳性（26 个月）的患者初次关节置换至部分翻修的中位时间明显缩短。初次翻修后 5 年内进行的部分翻修 5 年再翻修率更高。在部分翻修时仅有 1 次培养阳性与所有培养阴性（3 例中有 2 例，5.7%）相比，再翻修率（3 例中有 2 例，5.7%）并没有更高。相反，与所有培养阴性（3 例中有 1 例，3.1%）相比，≥2 次培养阳性（3 例中有 3 例，23.1%）的病例再翻修率明显更高（P =.02）。
初次翻修后 5 年内进行的部分翻修和≥2 次术中阳性培养与术后 5 年时再翻修风险增加相关。
