Department of Orthopaedics and Trauma Surgery, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
Department of Orthopaedics and Trauma Surgery, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain; Bone and Joint Infectious Diseases Unit, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain.
J Arthroplasty. 2025 Jan;40(1):191-197. doi: 10.1016/j.arth.2024.07.031. Epub 2024 Jul 23.
Our aim was to evaluate the prevalence and impact of unexpected positive intraoperative cultures (UPICs) on the outcome of presumed aseptic total knee and hip revision surgery.
Data regarding patients who underwent elective total hip or knee revision surgery from January 2003 to July 2017 due to preoperatively presumed aseptic reasons was retrospectively reviewed. Partial revisions and patients who had follow-ups below 60 months were excluded from the study. In all surgeries, at least 3 intraoperative samples were taken for microbial culture. Failure was defined as the need for rerevision due to any cause at 5 years and/or the need for antibiotic suppressive therapy. Overall, 123 total hip and 431 total knee revisions were eligible for the study. All cases had at least a 5 years follow-up.
There were 420 cases (75.8%) that had all cultures negative, 108 (19.5%) had a single UPIC, and 26 (4.7%) had either ≥2 UPICs for the same microorganism or 1 UPIC for a virulent microorganism. This latter group was not associated with a significantly higher failure rate (2 of 26, 7.7%) compared to those in the aseptic group (54 of 528, 10.2%). Revisions performed within the first 24 months after primary implantation had a higher 5-years rerevision rate (19.3 versus 8.4%, P = .01), mainly attributable to aseptic causes.
Total hip and knee revisions with UPICs were not significantly associated with a higher rerevision risk at 5 years. Those revisions performed within the first 24 months after primary arthroplasty had a higher rate of any-cause failure.
本研究旨在评估术中意外阳性培养（UPIC）对术前假定无菌性全膝关节和髋关节翻修手术结局的影响。
回顾性分析 2003 年 1 月至 2017 年 7 月期间因术前假定无菌原因接受择期全髋关节或全膝关节翻修手术的患者数据。排除部分翻修和随访时间不足 60 个月的患者。所有手术均至少采集 3 份术中样本进行微生物培养。失败定义为 5 年内因任何原因需要再次翻修和/或需要抗生素抑制性治疗。共纳入 123 例全髋关节和 431 例全膝关节翻修，所有病例均获得至少 5 年随访。
共有 420 例（75.8%）所有培养均为阴性，108 例（19.5%）有单个 UPIC，26 例（4.7%）有相同微生物的≥2 个 UPIC 或 1 个 UPIC 为毒力微生物。与无菌组（528 例中的 54 例，10.2%）相比，该组的翻修失败率（2 例，7.7%）无显著升高。初次植入后 24 个月内进行的翻修 5 年再次翻修率更高（19.3%比 8.4%，P=0.01），主要归因于无菌性原因。
UPIC 并不显著增加全髋关节和全膝关节翻修术 5 年的再次翻修风险。初次关节置换术后 24 个月内进行的翻修，任何原因导致的失败率更高。
