title: Microbiological culture findings of the femoral heads as a prognostic factor in the total hip replacement surgery.
abstract: BACKGROUND
  In primary total hip replacements (THRs), the dissected femoral heads (FHs) are commonly used to make the bone-chips for the reconstruction in the orthopaedic surgery. The donated FHs are routinely microbiologically cultured to identify and contaminated FHs are discarded. This study examines whether a positive FH culture predicts an infection and prosthetic failure after primary THR.
  
  
  METHODS
  The study sampled 274 donated FHs from patients with osteonecrosis (ON), hip joint osteoarthritis (OA), and femoral neck fracture (FNF) in THR to culture the microbes. The FH contamination rates were analyzed for ON, OA, and FNF groups. Proportion of the postoperative infection or prosthetic failure in the group of donors with a positive FH culture were compared to the proportion in the group of donors with a negative FH culture.
  
  
  RESULTS
  The rates of the positive culture in the ON, OA, and FNF groups were 7.1%, 3.8%, and 4.0%, respectively. The infection rate was found to be non-significantly greater in the ON group than in the OA and FNF groups. In the negative culture group, one patient (0.63%) had a postoperative superficial infection, and five patients (3.2%) experienced additional surgeries including a fixation for a periprosthetic fracture, within a minimum follow-up of two years. However, no postoperative infection was encountered, and no revision surgery was required in the positive culture group.
  
  
  CONCLUSIONS
  A positive FH culture is not always associated with elevated risks of infection or prosthetic failure after THR. Therefore, such finding cannot be used as a prognostic factor of THR. The FHs that return a positive culture may not lead to the orthopaedic assessment of an infection or other postoperative complication risks in primary THR.
authors.affiliation: Center for Joint Disease, Chonnam National University Hwasun Hospital, Hwasun, Korea.
authors.forename: Doan Thi Kim
authors.initials: DT
authors.lastname: Phuong
authors.forename: Kyung Soon
authors.initials: KS
authors.lastname: Park
authors.forename: Sang Yun
authors.initials: SY
authors.lastname: Hwang
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Lee
authors.forename: Taek Rim
authors.initials: TR
authors.lastname: Yoon
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery; D005270:Femur Head / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery; D010020:Osteonecrosis / Q000601:surgery; D011379:Prognosis; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D013210:Staphylococcus / Q000302:isolation & purification
keywords: Femoral head; Positive culture; Total hip replacement