Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection
- 1 November 2013
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Clinical Orthopaedics and Related Research
- Vol. 471 (11), 3672-3678
- https://doi.org/10.1007/s11999-013-3200-7
Abstract
The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI). We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis. All patients undergoing revision surgery between July 2010 and January 2012 were included in a prospective cohort of 112 patients, and were classified as having had failure from aseptic loosening (56%), mechanical failure (15%), or PJI (29%). To make the diagnosis of PJI, at surgery we used a standardized enhanced diagnostic approach in all patients including sampling of five periprosthetic tissue specimens, sonication of removed prosthetic components, prolonged incubation of aerobic and anaerobic cultures, and multiplex PCR of sonication fluid in aseptic loosening cases. Kaplan-Meier survival and Cox proportional hazards regression analysis were performed. The median time from primary to revision surgery was (p < 0.001) longer for patients with aseptic loosening (7.8 years) than for patients with mechanical failure (1.6 years) or PJI (2 years). No difference in the time to revision was observed for patients with aseptic loosening with positive or negative microbiological cultures (p = 0.594). Propionibacterium acnes was cultured below the established microbiological criteria for positivity in 12 (19%) procedures that had been presumed to have been revisions for aseptic loosening. PJI should be considered in all revisions performed within 2 years of implantation even in the absence of clinical or laboratory findings suggestive for infection. However, the growth of low-virulence microorganisms below the cut-off in revisions for apparent aseptic loosening is not associated with early prosthesis failure.Keywords
This publication has 32 references indexed in Scilit:
- Epidemiology and New Developments in the Diagnosis of Prosthetic Joint InfectionThe International Journal of Artificial Organs, 2012
- Low sensitivity of histology to predict the presence of microorganisms in suspected aseptic loosening of a joint prosthesisLaboratory Investigation, 2006
- Is Aseptic Loosening Truly Aseptic?Clinical Orthopaedics and Related Research, 2005
- Prosthetic joint infections: update in diagnosis and treatment.2005
- Is “Aseptic” Loosening of the Prosthetic Cup after Total Hip Replacement Due to Nonculturable Bacterial Pathogens in Patients with Low‐Grade Infection?Clinical Infectious Diseases, 2004
- Synovial fluid leukocyte count and differential for the diagnosis of prosthetic knee infectionThe American Journal of Medicine, 2004
- Prosthetic-Joint InfectionsThe New England Journal of Medicine, 2004
- THE SWEDISH TOTAL HIP REPLACEMENT REGISTERPublished by Ovid Technologies (Wolters Kluwer Health) ,2002
- The Norwegian Arthroplasty Register: 11 years and 73,000 arthroplastiesActa Orthopaedica, 2000
- The problem is osteolysis.1995