Multiple Cultures and Extended Incubation for Hip and Knee Arthroplasty Revision: Impact on Clinical Care

Abstract The impact on patient care of introducing a protocol of obtaining 5 or more intra-operative separate tissue biopsies that were cultured for 10 days was assessed for hip and knee arthroplasty revision. The charts of seventy-three patients undergoing 77 cases of revision arthroplasty were rev...

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Bibliographic Details
Published in:The Journal of arthroplasty 2013-09, Vol.28 (8), p.59-65
Main Authors: DeHaan, Alexander, MD, Huff, Thomas, MD, Schabel, Kathryn, MD, Doung, Yee-Cheen, MD, Hayden, James, MD, PhD, Barnes, Penelope, MBBS PhD
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - therapeutic use
Arthroplasty, Replacement, Hip - instrumentation
Arthroplasty, Replacement, Knee - instrumentation
Biopsy
Disease Management
Female
Follow-Up Studies
hip arthroplasty
Hip Joint - microbiology
Hip Joint - pathology
Hip Joint - surgery
Hip Prosthesis - microbiology
Humans
infection
Intraoperative Period
knee arthroplasty
Knee Joint - microbiology
Knee Joint - pathology
Knee Joint - surgery
Knee Prosthesis - microbiology
Male
Microbiological Techniques - methods
Middle Aged
multiple cultures
Orthopedics
Prosthesis Failure
Prosthesis-Related Infections - diagnosis
Prosthesis-Related Infections - drug therapy
Prosthesis-Related Infections - microbiology
Reoperation
Retrospective Studies
revision arthroplasty
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Summary:Abstract The impact on patient care of introducing a protocol of obtaining 5 or more intra-operative separate tissue biopsies that were cultured for 10 days was assessed for hip and knee arthroplasty revision. The charts of seventy-three patients undergoing 77 cases of revision arthroplasty were reviewed one year post-operatively. When compared to the prior standard of obtaining only one intra-operative culture, the protocol changed the microbiological diagnosis in 26/77 cases (34%, 95% Confidence Interval (CI): 23–45%) and antibiotic treatment in 23/77 cases (30%, 95% CI: 20–41%). In addition, the protocol had a predictive value of joint sterility in culture negative cases of 95% (95% CI: 85–99%). This data demonstrated the new protocol significantly changed patient care, and suggests that 1 or 2 cultures are insufficient. Adopting a similar protocol should be considered by surgeons and institutions as a new minimum standard for management of prosthetic joint infections.
ISSN:0883-5403
1532-8406
DOI:10.1016/j.arth.2013.03.037