Schwarze Jan, Dieckmann Ralf, Gosheger Georg, Bensmann Matthias, Moellenbeck Burkhard, Theil Christoph
Department of Orthopedics and Tumor Orthopedics, Muenster University Hospital, Muenster, Germany.
Department for Orthopaedics and Trauma Surgery, Krankenhaus der Barmherzigen Brueder Trier, Trier, Germany.
J Arthroplasty. 2022 Jun;37(6):1165-1172. doi: 10.1016/j.arth.2022.02.054. Epub 2022 Feb 19.
Unsuspected positive cultures (UPCs) may be found at the time of planned aseptic revision surgery and have previously been associated with decreased implant survival. However, reported rates vary greatly, and potential risk factors are widely unknown. This study investigates the rate of UPCs, implant survival, as well as potential risk factors for UPCs and revision.
This is a retrospective, single-center study on 434 cases of total hip arthroplasty (THA 277) and knee revision arthroplasty (TKA 157) performed between 2010 and 2017. Microbiology culture results, revision-free survival (RFS) and infection-free (IFS) survival, and the potential impact of UPCs as well as patient- or procedure-related risk factors were investigated at a minimum follow-up of 24 months (median 41 months).
A total of 37% of patients had a positive culture (160/434). 27% (119/434) had a solitary positive culture, and 9% (41/434) had ≥2 positive cultures of the same species. Most commonly, coagulase-negative staphylococci were cultured. Overall, 32% (13/41) of patients with ≥2 positive cultures underwent revision for infection compared with 6% (17/274) of patients with negative cultures. RFS and IFS were reduced if ≥2 cultures were positive. Single positive cultures had no impact on RFS or IFS. Male sex, elevated serum C-reactive protein, and obesity were independently associated with finding ≥2 UPCs in revision THA.
Appearance of ≥2 UPCs in aseptic revision leads to reduced RFS and IFS. Males, obese patients, and patients with elevated serum C-reactive protein planned for THA revision should be considered for extended diagnostics to rule out periprosthetic joint infection.
在计划进行的无菌翻修手术时可能会发现意外的阳性培养结果（UPCs），且此前已发现其与植入物存活率降低有关。然而，报道的发生率差异很大，潜在危险因素也广为人知。本研究调查了UPCs的发生率、植入物存活率以及UPCs和翻修的潜在危险因素。
这是一项回顾性单中心研究，纳入了2010年至2017年间进行的434例全髋关节置换术（THA 277例）和膝关节翻修置换术（TKA 157例）。在至少24个月（中位41个月）的随访中，研究了微生物培养结果、无翻修存活（RFS）和无感染存活（IFS），以及UPCs的潜在影响以及患者或手术相关的危险因素。
共有37%的患者培养结果为阳性（160/434）。27%（119/434）为单一阳性培养结果，9%（41/434）有≥2个相同菌种的阳性培养结果。最常培养出凝固酶阴性葡萄球菌。总体而言，≥2个阳性培养结果的患者中有32%（13/41）因感染进行了翻修，而培养结果为阴性的患者中这一比例为6%（17/274）。如果≥2个培养结果为阳性，则RFS和IFS降低。单一阳性培养结果对RFS或IFS无影响。男性、血清C反应蛋白升高和肥胖与翻修THA中发现≥2个UPCs独立相关。
无菌翻修中出现≥2个UPCs会导致RFS和IFS降低。对于计划进行THA翻修的男性、肥胖患者和血清C反应蛋白升高的患者，应考虑进行进一步诊断以排除假体周围关节感染。
