Department of Orthopaedics, Charité Universitaetsmedizin Berlin, Centre for Musculoskeletal Surgery, Berlin, Germany.
Department of Orthopaedics, Universitaetsmedizin Greifswald, Greifswald, Germany.
Bone Joint J. 2021 Jun;103-B(6):1070-1077. doi: 10.1302/0301-620X.103B6.BJJ-2020-2002.R1.
The purpose of this study was to evaluate unexpected positive cultures in total hip arthroplasty (THA) revisions for presumed aseptic loosening, to assess the prevalence of low-grade infection using two definition criteria, and to analyze its impact on implant survival after revision.
A total of 274 THA revisions performed for presumed aseptic loosening from 2012 to 2016 were reviewed. In addition to obtaining intraoperative tissue cultures from all patients, synovial and sonication fluid samples of the removed implant were obtained in 215 cases (79%) and 101 cases (37%), respectively. Histopathological analysis was performed in 250 cases (91%). Patients were classified as having low-grade infections according to institutional criteria and Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) 2013 criteria. Low-grade infections according to institutional criteria were treated with targeted antibiotics for six weeks postoperatively. Implant failure was defined as the need for re-revision resulting from periprosthetic joint infection (PJI) and aseptic reasons. The mean follow-up was 68 months (26 to 95).
Unexpected positive intraoperative samples were found in 77 revisions (28%). Low-grade infection was diagnosed in 36 cases (13%) using institutional criteria and in nine cases (3%) using MSIS ICM 2013 criteria. In all, 41 patients (15%) had single specimen growth of a low-virulent pathogen and were deemed contaminated. Coagulase-negative and anaerobes were the most commonly isolated bacteria. Implant failure for PJI was higher in revisions with presumed contaminants (5/41, 12%) compared to those with low-grade infections (2/36, 6%) and those with negative samples (5/197, 3%) (p = 0.021). The rate of all-cause re-revision was similar in patients diagnosed with low-grade infections (5/36, 14%) and those with presumed contaminants (6/41, 15%) and negative samples (21/197, 11%) (p = 0.699).
Our findings suggest that the presumption of culture contamination in aseptic revision hip arthroplasty may increase the detection of PJI. In this cohort, the presence of low-grade infection did not increase the risk of re-revision. Further studies are needed to assess the relevance of single specimen growth and the benefits of specific postoperative antibiotic regimens. Cite this article: 2021;103-B(6):1070-1077.
本研究旨在评估假定无菌性松动的全髋关节翻修术中意外阳性培养物，使用两种定义标准评估低度感染的发生率，并分析其对翻修后植入物存活率的影响。
回顾了 2012 年至 2016 年间因假定无菌性松动而行的 274 例全髋关节翻修术。除了从所有患者术中获得组织培养物外，还分别在 215 例（79%）和 101 例（37%）患者中获得了去除植入物的滑膜和超声冲洗液样本。250 例（91%）患者进行了组织病理学分析。根据机构标准和肌肉骨骼感染协会（MSIS）国际共识会议（ICM）2013 标准，将患者分为低度感染。根据机构标准，低度感染患者术后接受六周靶向抗生素治疗。植入物失败定义为需要因假体周围关节感染（PJI）和无菌原因进行再次翻修。平均随访 68 个月（26 至 95 个月）。
77 例（28%）术中样本意外呈阳性。根据机构标准，36 例（13%）诊断为低度感染，9 例（3%）根据 MSIS ICM 2013 标准诊断为低度感染。共有 41 例（15%）患者单一标本培养出低毒病原体，被认为是污染。凝固酶阴性菌和厌氧菌是最常见的分离细菌。与低度感染（2/36，6%）和阴性样本（5/197，3%）相比，假定为污染物的翻修术（5/41，12%）中 PJI 导致的植入物失败率更高（p=0.021）。诊断为低度感染（5/36，14%）、假定为污染物（6/41，15%）和阴性样本（21/197，11%）的患者再次翻修的总发生率相似（p=0.699）。
我们的研究结果表明，在无菌性髋关节翻修术中假定培养物污染可能会增加 PJI 的检出率。在本队列中，低度感染的存在并未增加再次翻修的风险。需要进一步研究来评估单一标本生长的相关性和特定术后抗生素方案的益处。
引用本文：2021;103-B(6):1070-1077.
