Abstract
Little is known about patients that undergo presumed aseptic revision arthroplasty surgery of the hip and knee joint and having positive microbiological findings of the intraoperatively taken tissue samples. 228 “aseptic” operations were retrospectively analyzed from prospectively collected data with regard to the following parameters: demographic data; reasons for primary and revision surgery, respectively; time between primary and revision surgery; preoperative laboratory findings; microbiological and histopathological findings; type and length of systemic antibiotic therapy; clinical outcome; and follow-up. Identification of microorganisms was present in 8.8% of the cases (9.3% of the hip and 7.8% of the knee cases). Preoperatively, the median CRP value was 8.4 mg/l (normal values 0-5.0 mg/l) and the median WBC count 8,100 × 106/l (normal values 3, 700‐10,100 × 106/l). The most common identified organism was methicillin-resistant Staphylococcus epidermidis in 30%, followed by viridans streptococci in 15% of the cases. In 7 cases, the microbiological findings were interpreted as a contamination, and no antibiotic therapy was administered. In the other cases, a systemic antibiotic therapy was applied for a time period between 2 weeks and 3 months. 68.4% of the patients did not have any infectious complications at a median follow-up of 20 (3-42) months. The present study indicates that more than 2/3 of the cases with positive microbiological findings at the site of presumed aseptic revision arthroplasty surgery of the hip and knee joint can be successfully treated conservatively and they do not require any further surgical therapy.
Highlights
Periprosthetic joint infections (PJI) pose a rare but hazardous complication after total hip and knee arthroplasty
Only few studies have dealt with this topic [9,10,11,12,13,14], clinical practice shows that orthopedic surgeons, who perform revision arthroplasty surgeries, are not infrequently confronted with this phenomenon
The remaining 228 “aseptic” operations were retrospectively analyzed from prospectively collected data with regard to following parameters: demographic data; reasons for primary and revision surgery, respectively; time between primary and revision surgery; preoperative laboratory findings (C-reactive protein (CRP); white blood cell (WBC) count); microbiological and histopathological findings; type and length of systemic antibiotic therapy; clinical outcome; and follow-up
Summary
Periprosthetic joint infections (PJI) pose a rare but hazardous complication after total hip and knee arthroplasty. Only few studies have dealt with this topic [9,10,11,12,13,14], clinical practice shows that orthopedic surgeons, who perform revision arthroplasty surgeries, are not infrequently confronted with this phenomenon. For these cases, the ideal further treatment remains unknown. It is unclear whether these patients require systemic antibiotic treatment and, if yes, for how long. It is unknown whether repeated prosthesis-retaining revisions or even a removal of the prosthesis should be planned
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