Abstract
BackgroundThe effect of negative culture on the treatment outcomes of chronic periprosthetic joint infection (PJI) is still controversial. The purpose of this study is to evaluate whether the outcomes of two-stage revision in culture-negative chronic PJI differ from those in culture-positive PJI.MethodsThe patients who received two-stage revisions due to chronic PJI during the period between 2007 and 2017 were retrospectively reviewed. The culture-negative and culture-positive PJI group included 57 cases and 79 cases, respectively. The demographic data, as well as reoperation, mortality, reinfection, and failure rates of each group were evaluated.ResultsThere was a significant difference in reoperation rate between the two groups for the period from the first-stage surgery to the second-stage revision arthroplasty (p = 0.045). The reoperation rate of the culture-positive group was 25.3% (20/79) whereas that of the culture-negative group was 10.5% (6/57). Among the 136 PJI cases, 97 cases (71.3%) received reimplantation surgery (culture-negative group, 43 cases; culture-positive group, 54 cases). No significant difference was noted between the culture-negative and culture-positive groups with respect to the number of cases that did not undergo reimplantation surgery and the reoperation, reinfection, mortality, and failure rates after two-stage surgery (p > 0.05, all parameters).ConclusionsThe culture outcome had no significant effect on the outcome of the two-stage revision in patients with chronic PJI. The reoperation rate after first-stage surgery was significantly higher in the culture-positive group, but the overall failure rate did not significantly differ in both the groups. The presence of a negative culture might be a good prognostic factor for chronic PJI.
Highlights
The effect of negative culture on the treatment outcomes of chronic periprosthetic joint infection (PJI) is still controversial
The purpose of this study is to evaluate whether the outcomes of a two-stage revision in culture-negative chronic PJI differs from those in culture-positive PJI
The major criteria include: (1) two positive periprosthetic cultures with phenotypically identical organisms and (2) a sinus tract communicating with the joint, whereas the minor criteria include: (1) increased serum erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) (ESR > 30 mm/h and CRP > 10 mg/L), (2) increased synovial-fluid white blood cell (WBC) count (> 3000 cells/μL), (3) increased synovial polymorphonuclear neutrophil (PMN) percentage (≥ 80%), (4) more than five neutrophils per high-power field (HPF) in five HPFs (× 400), and (5) a single positive culture
Summary
The effect of negative culture on the treatment outcomes of chronic periprosthetic joint infection (PJI) is still controversial. Periprosthetic joint infection (PJI) is one of the most serious complications that can occur after total knee arthroplasty (TKA) and is known to be one of the major causes of early failure [1,2,3]. Isolation of the infecting organism failed in more than 40% of the PJI cases [4,5,6]. A negative culture can delay the diagnosis, making it difficult to determine an appropriate treatment method [6]. Multiple groups, including the Musculoskeletal Infection Society (MSIS), have proposed a diagnostic guideline for PJI. The detection of a causative organism based on the culture method is still believed to be an important factor in diagnosis
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