Periprosthetic joint infection (PJI) is a devastating complication in revision total hip arthroplasty (THA). As preoperative diagnosis can be difficult, some patients who undergo planned aseptic revision surgery might have positive intraoperative cultures and later be classified as infected. In this retrospective study we analyzed the influence of intraoperative positive cultures and possible underlying risk factors in patients undergoing planned aseptic THA revision. We retrospectively analyzed 276 cases of aseptic THA revision surgery between 2010 and 2017 who had a minimum follow-up period of 24 months. All patients underwent preoperative serum and synovial diagnostics according to the Center of Disease Control (CDC) (2010) or Musculoskeletal Infection Society (MSIS) Criteria (2011–2017) for PJI and were classified as aseptic prior to surgery. In all cases intraoperative tissue samples were taken and reviewed. Primary endpoint was defined as any complication leading to revision surgery. Secondary endpoint was explantation due to PJI or death. Revision free survival (RFS) and infection free survival (IFS) for intraoperative negative and positive cultures was calculated via Kaplan Meyer Method. Patients’ medical history was analyzed for possible risk factors for positive cultures.Aim
Method
Due to medical and organizational factors, it occurs in everyday practice that spacers are left in place longer than originally planned during a two-stage prosthesis exchange in the case of prosthetic joint infections. Patients are severely restricted in their mobility and, after initial antibiotic administration, the spacer itself only acts as a foreign body. The aim of this study is to analyze whether the duration of the spacer in situ has an influence on the long-term success of treatment and mortality. We retrospectively studied all 204 two-stage prosthesis replacements of the hip and knee from 2012 to 2016 with a minimum follow-up of two years at an arthroplasty center with 3 main surgeons. The duration of the spacer interval was divided into two groups. Patients replanted within ten weeks (as is standard in multiple algorithms) after systemic antibiotic treatment were assigned to the ‘Regular Spacer Interval (< 70 days)’ group. If the spacer interval was longer, they were assigned to the ‘Long Spacer Interval (≥ 70 days)’ group.Aim
Method
Periprosthetic fungal infections are rare and account for 1–2% of all periprosthetic joint infections (PJI). This study aims at presenting treatment details, clinical and microbiological results in a large single centre cohort. We retrospectively identified 29 patients (9 total knee replacements (TKA) and 20 total hip replacements (THA) treated for a fungal infection between 2007 and 2019. Microbiological findings, patient demographics and complications were analysed. Statistical analysis was performed using descriptive statistics; non-parametric analysis were performed using the Mann-Whitney U-Test. Infection-free survival was determined using Kaplan-Meier analysis and differences in survival were analysed using the log-rank test. The p value was set at p<0.05 with 95% confidence intervals (95% CI) provided.Aims
Methods
Diagnosis and isolation of a causative organism is imperative for successful treatment of periprosthetic joint infections (PJI). While there are several diagnostic algorithms using microbiology, serum and synovial markers, the preoperative diagnosis of a low-grade infection remains a challenge, particularly in patients with unsuccessful aspiration. An incisional biopsy may be used in these cases as additional diagnostic tool. In this retrospective study we evaluated microbiological findings, sensitivity, and specificity of open synovial biopsies in cases of inconclusive preoperative diagnostics. In a retrospective databank analysis (2010–2018), we identified 80 TKAs that underwent an open biopsy because of inconclusive results after applying the CDC Criteria (2010) or the MSIS (2011–2018) for PJI. Infection makers in the serum (C-reactive protein [CRP], leucocytes count and interleukin-6 [IL-6]) and in the synovial aspirate (leucocyte count, percentage of neutrophiles) prior to the biopsy were analyzed. All biopsies were performed by suprapatellar mini-arthrotomy. If a subsequent revision surgery was performed, the isolated organisms in the open biopsy were compared to the results in the revision surgery and sensitivity and specificity were calculated. Serum markers were checked for correlation with a positive result in the open biopsy using Cramer-V and Chi2-Test.Aim
Methods
