title: Revision total knee arthroplasty: infection should be ruled out in all cases.
abstract: We hypothesized that some aseptic revision total knee arthroplasty failures are indeed caused by occult infection. This prospective study recruited 65 patients undergoing revision total knee arthroplasty. The mean follow-up period was 19 months. Collected synovial fluid was analyzed by Ibis T5000 biosensor (Abbott Molecular Inc, Ill; a multiplex polymerase chain reaction technology). Cases were considered as infected or aseptic based on the surgeon's judgment and Ibis findings. Based on Ibis biosensor, 17 aseptic cases were indeed infected that had been missed. Of these 17 cases, 2 developed infection after the index revision. A considerable number of so-called aseptic failures seem to be occult infections that were not adequately investigated and/or miscategorized as aseptic failure. We recommend that all patients undergoing revision arthroplasty be investigated for periprosthetic joint infection.
authors.affiliation: Rothman Institute of Orthopaedics at Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Rasouli
authors.forename: Armin Aalami
authors.initials: AA
authors.lastname: Harandi
authors.forename: Bahar
authors.initials: B
authors.lastname: Adeli
authors.forename: James J
authors.initials: JJ
authors.lastname: Purtill
authors.forename: Javad
authors.initials: J
authors.lastname: Parvizi
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee; D001707:Biopsy, Needle; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007719:Knee Joint / Q000382:microbiology / Q000473:pathology / Q000601:surgery; D007720:Knee Prosthesis / Q000382:microbiology*; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology*; D012086:Reoperation; D013582:Synovial Fluid / Q000382:microbiology
chemical_list: D002097:C-Reactive Protein