Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection

Int Orthop. 2011 May;35(5):647-54. doi: 10.1007/s00264-010-1014-8. Epub 2010 Apr 27.

Abstract

During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a two-stage revision. A total of 62 PJI were found in 58 patients. All patients had intra-operative surgical exploration during re-implantation, and 48 of them had intra-operative microbiological swabs. Additionally, 18 joint aspirations and one open biopsy were performed before second-stage reimplantation. Recurrence or persistence of PJI occurred in 12 cases with a mean delay of 218 days after re-implantation, but only four pre- or intraoperative invasive joint samples had grown a pathogen in cultures. In at least seven recurrent PJIs (58%), patients had a normal C-reactive protein (CRP, < 10 mg/l) level before re-implantation. The sensitivity, specificity, positive predictive and negative predictive values of pre-operative invasive joint aspiration and CRP for the prediction of PJI recurrence was 0.58, 0.88, 0.5, 0.84 and 0.17, 0.81, 0.13, 0.86, respectively. As a conclusion, pre-operative joint aspiration, intraoperative bacterial sampling, surgical exploration and serum inflammatory markers are poor predictors of PJI recurrence. The onset of reinfection usually occurs far later than reimplantation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Arthroplasty, Replacement, Hip / adverse effects*
  • Arthroplasty, Replacement, Knee / adverse effects*
  • Bacteriological Techniques
  • C-Reactive Protein / analysis
  • False Negative Reactions
  • False Positive Reactions
  • Female
  • Hip Joint / microbiology
  • Hip Joint / surgery
  • Humans
  • Intraoperative Period
  • Knee Joint / microbiology
  • Knee Joint / surgery
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prosthesis-Related Infections / blood
  • Prosthesis-Related Infections / diagnosis*
  • Prosthesis-Related Infections / microbiology
  • Recurrence
  • Reoperation
  • Retrospective Studies
  • Suction / methods

Substances

  • C-Reactive Protein