title: Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection.
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.
authors.affiliation: Orthopaedic Surgery Service, Geneva University Hospitals, Geneva, Switzerland.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Schindler
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Christofilopoulos
authors.forename: Blaise
authors.initials: B
authors.lastname: Wyssa
authors.forename: Wilson
authors.initials: W
authors.lastname: Belaieff
authors.forename: Christian
authors.initials: C
authors.lastname: Garzoni
authors.forename: Louis
authors.initials: L
authors.lastname: Bernard
authors.forename: Daniel
authors.initials: D
authors.lastname: Lew
authors.forename: Pierre
authors.initials: P
authors.lastname: Hoffmeyer
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001431:Bacteriological Techniques; D002097:C-Reactive Protein / Q000032:analysis; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D006621:Hip Joint / Q000382:microbiology / Q000601:surgery; D006801:Humans; D007432:Intraoperative Period; D007719:Knee Joint / Q000382:microbiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis* / Q000382:microbiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013396:Suction / Q000379:methods
chemical_list: D002097:C-Reactive Protein