Abstract
Introduction
Cutibacterium acnes (C. acnes) is now recognized as a clinical entity in periprosthetic joint infections (PJI) of the shoulder and spine. However, the colonization rate of C. acnes in the adult hip is currently unknown. Therefore, the purpose of this study was to investigate the rate of C. acnes colonization from the skin of healthy subjects from various anatomic locations corresponding to direct anterior and lateral/posterolateral surgical approaches.
Methods
90 patients scheduled for hip or knee surgery were recruited for cultured biopsies. Four 3-mm dermal punch biopsies were collected after administration of anesthesia, but prior to delivery of perioperative antibiotics. Pre-biopsy skin prep consisted of a standardized pre-operative 2% chlorhexidine skin cleanse and an additional 70% isopropyl alcohol mechanical skin scrub immediately prior to biopsy collection. Two culture samples 10-cm apart were collected from a location approximating a standard direct anterior skin incision, and two samples 10-cm apart were collected from a location approximating a lateral skin incision (suitable for a posterior, direct-lateral or anterolateral surgical approach). Samples were cultured for two weeks.
Results
22 of the 90 (24%) patients had a positive culture biopsy, fourteen of which (16% of all patients) were positive for C. acnes. Ten (71%) of the culture positive biopsies for C. acnes were obtained from the anterior location with 50% of those obtained from the most proximal sample site.
Conclusions
Approximately 16% of the patients in the study demonstrated positive C. acnes colonization about the hip, the majority of which occurred from an anterior location. C. acnes should be considered in the diagnosis of PJI after THA. Given the high rate of skin colonization, particularly as regards the direct anterior approach to the hip, these results have stimulated consideration for different skin preparations for the THA patient.
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