Abstract
AimsPreoperative aspiration culture and intraoperative cultures play pivotal roles in periprosthetic joint infection (PJI) diagnosis and pathogen identification. But the discordance between preoperative aspiration culture and intraoperative synovial fluid culture remains unknown. We aim to determine (1) the discordance between preoperative and intraoperative synovial fluid (SF) culture and. (2) compared to intraoperative synovial fluid cultures, the sensitivity of preoperative aspiration fluid culture. Then the following question is tried to be answered: Are intraoperative synovial fluid re-cultures necessary if the preoperative aspiration culture is positive?Materials and methodsBetween 2015 and 2019, 187 PJI patients managed with surgeries were included in this study. Compared to intraoperative synovial fluid culture, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of preoperative aspiration culture were calculated. Then, the discordance between preoperative aspiration culture and intraoperative SF culture was analyzed.ResultsThe sensitivity of preoperative aspiration culture was 81.29% compared to intraoperative synovial fluid cultures. Concordance was identified in 147 PJI (78.61%) patients and culture discordance occurred in 40 patients (21.39%). In these discordant PJI patients, 24 patients (60%) were polymicrobial and no intraoperative synovial fluid culture growth was found in 16 PJI cases (40%). Preoperative monomicrobial staphylococcus results had a sensitivity of and a specificity of 80.43% and 83.16%, respectively. Preoperative polymicrobial results had the lowest sensitivity.ConclusionsThe intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture.Level of evidence: Level III.
Highlights
Periprosthetic joint infection (PJI), is a serious complication after total joint arthroplasties (TJA) and lays a huge burden on patients, surgeons, and healthcare systems worldwide [1,2,3]
The intraoperative synovial fluid re-cultures are necessary if the preoperative aspiration culture is positive and the discordance between preoperative aspiration culture and intraoperative synovial fluid culture should be noted especially when Streptococcus spp. and more than one pathogen was revealed by preoperative aspiration culture
Demographic characteristics Between 2015 and 2019, a total of 187 PJI patients managed with surgeries were included in this study
Summary
Periprosthetic joint infection (PJI), is a serious complication after total joint arthroplasties (TJA) and lays a huge burden on patients, surgeons, and healthcare systems worldwide [1,2,3]. If a microorganism of low virulence was detected in a single specimen, PJI was highly suspected According to these criteria, a problem was raised: are intraoperative synovial fluid re-cultures necessary if preoperative aspiration culture is positive. If a microorganism of high-virulence was detected in the preoperative aspiration culture, there may be no need to perform intra-op synovial fluid culture again because the PJI pathogen has been identified and extra tests increase the cost of PJI management. If a microorganism of lowvirulence was detected in the preoperative aspiration culture, it may be necessary to perform an intra-op synovial fluid culture to further identify the specific PJI pathogen [7] To address this problem, a retrospective study was conducted in a tertiary joint center to determine (1) the discordance between preoperative synovial fluid culture and intraoperative synovial fluid culture. We try to answer this question: Are intraoperative synovial fluid cultures necessary if the preoperative aspiration culture is positive
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