Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Paper
  • Published:
International Orthopaedics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654

    Article  PubMed  CAS  Google Scholar 

  2. Hanssen AD, Trousdale RT, Osmon DR (1995) Patient outcome with reinfection following reimplantation for the infected total knee arthroplasty. Clin Orthop Relat Res 321:55–67

    PubMed  Google Scholar 

  3. Mont MA, Waldman BJ, Hungerford DS (2000) Evaluation of preoperative cultures before second-stage reimplantation of a total knee prosthesis complicated by infection. A comparison-group study. J Bone Joint Surg Am 82:1552–1557

    PubMed  Google Scholar 

  4. Hsieh PH, Shih CH, Chang YH, Lee MS, Shih HN, Yang WE (2004) Two-stage revision hip arthroplasty for infection: comparison between the interim use of antibiotic-loaded cement beads and a spacer prosthesis. J Bone Joint Surg Am 86:1989–1997

    PubMed  Google Scholar 

  5. Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R (2007) Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med 16:654–663

    Article  Google Scholar 

  6. Kraay MJ, Goldberg VM, Fitzgerald SJ, Salata MJ (2005) Cementless two-staged total hip arthroplasty for deep periprosthetic infection. Clin Orthop Relat Res 441:243–249

    Article  PubMed  Google Scholar 

  7. Müller M, Morawietz L, Hasart O, Strube P, Perka C, Tohtz S (2008) Diagnosis of periprosthetic infection following total hip arthroplasty—evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection. J Orthop Surg Res 21:31–39

    Article  Google Scholar 

  8. Ghanem E, Azzam K, Seeley M, Joshi A, Parvizi J (2009) Staged revision for knee arthroplasty infection: what is the role of serologic tests before reimplantation? Clin Orthop Relat Res 467:1699–1705

    Article  PubMed  Google Scholar 

  9. Uçkay I, Vernaz-Hegi N, Harbarth S, Stern R, Legout L, Vauthey L, Ferry T, Lübbeke A, Assal M, Lew D, Hoffmeyer P, Bernard L (2009) Activity and impact on antibiotic use and costs of a dedicated infectious diseases consultant on a septic orthopaedic unit. J Infect 58:205–212

    Article  PubMed  Google Scholar 

  10. Uçkay I, Lübbeke A, Emonet S, Tovmirzaeva L, Stern R, Ferry T, Assal M, Bernard L, Lew D, Hoffmeyer P (2009) Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections. J Infect 59:337–345

    Article  PubMed  Google Scholar 

  11. Wayne P (2007) Performance standards for antimicrobial susceptibility testing. 17th informational supplement. Clinical and Laboratory Standards Institute. Standard M100-S17

  12. Hanssen AD, Osmon DR (2002) Evaluation of a staging system for infected hip arthroplasty. Clin Orthop Relat Res 403:16–22

    Article  PubMed  Google Scholar 

  13. Nestor BJ, Hanssen AD, Ferrer-Gonzalez R, Fitzgerald RH (1994) The use of porous prostheses in delayed reconstruction of total hip replacements that have failed because of infection. J Bone Joint Surg Am 762:349–359

    Google Scholar 

  14. Jämsen E, Stogiannidis I, Malmivaara A, Pajamäki J, Puolakka T, Konttinen YT (2009) Outcome of prosthesis exchange for infected knee arthroplasty: the effect of treatment approach. Acta Orthop 80:67–77

    Article  PubMed  Google Scholar 

  15. Raut VV, Siney PD, Wroblewski BM (1995) One-stage revision of total hip arthroplasty for deep infection. Long-term followup. Clin Orthop Relat Res 321:202–207

    PubMed  Google Scholar 

  16. McDonald DJ, Fitzgerald RH Jr, Ilstrup DM (1989) Two-stage reconstruction of a total hip arthroplasty because of infection. J Bone Joint Surg Am 71:828–834

    PubMed  CAS  Google Scholar 

  17. Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR (1998) Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol 36:2932–2939

    PubMed  CAS  Google Scholar 

  18. Uçkay I, Assal M, Legout L, Rohner P, Stern R, Lew D, Hoffmeyer P, Bernard L (2006) Recurrent osteomyelitis caused by infection with different bacterial strains without obvious source of reinfection. J Clin Microbiol 44:1194–1196

    Article  PubMed  Google Scholar 

  19. Morgan PM, Sharkey P, Ghanem E, Parvizi J, Clohisy JC, Burnett RS, Barrack RL (2009) The value of intraoperative Gram stain in revision total knee arthroplasty. J Bone Joint Surg Am 91:2124–2129

    Article  PubMed  Google Scholar 

  20. Greidanus NV, Masri BA, Garbuz DS, Wilson SD, McAlinden MG, Xu M, Duncan CP (2007) Use of erythrocyte sedimentation rate and C-reactive protein level to diagnose infection before revision total knee arthroplasty. A prospective evaluation. J Bone Joint Surg Am 89:1409–1416

    Article  PubMed  Google Scholar 

  21. Unkila-Kallio L, Kallio MJ, Eskola J, Peltola H (1994) Serum C-reactive protein, erythrocyte sedimentation rate, and white blood cell count in acute hematogenous osteomyelitis of children. Pediatrics 93:59–62

    PubMed  CAS  Google Scholar 

  22. Pääkkönen M, Kallio MJ, Kallio PE, Peltola H (2010) Sensitivity of erythrocyte sedimentation rate and C-reactive protein in childhood bone and joint infections. Clin Orthop Relat Res 468:861–866

    Article  PubMed  Google Scholar 

  23. Khan MH, Smith PN, Rao N, Donaldson WF (2006) Serum C-reactive protein levels correlate with clinical response in patients treated with antibiotics for wound infections after spinal surgery. Spine J 6:311–315

    Article  PubMed  Google Scholar 

  24. Duff GP, Lachiewicz PF, Kelley SS (1996) Aspiration of the knee joint before revision arthroplasty. Clin Orthop Relat Res 31:132–139

    Article  Google Scholar 

  25. Vandercam B, Jeumont S, Cornu O, Yombi JC, Lecouvet F, Lefèvre P, Irenge LM, Gala JL (2008) Amplification-based DNA analysis in the diagnosis of prosthetic joint infection. J Mol Diagn 10:537–543

    Article  PubMed  Google Scholar 

  26. Lorrot M, Fitoussi F, Faye A, Mariani P, Job-Deslandre C, Penneçot GF, Bingen E, Bourrillon A (2007) Laboratory studies in pediatric bone and joint infections. Archives de Pédiatrie 14:86–90

    Article  Google Scholar 

Download references

Acknowledgements

We are indebted to Christophe Barea and Mamadou Toure for retrieving data. We thank to all colleagues of the Orthopaedic Service and the Microbiological Laboratory for their help.

Author information

Authors and Affiliations

  1. Orthopaedic Surgery Service, Geneva University Hospitals, 4, Rue Gabrielle Perret-Gentil, 1211, Geneva 14, Switzerland

    Maximilian Schindler, Panayiotis Christofilopoulos, Blaise Wyssa, Wilson Belaieff, Pierre Hoffmeyer & Ilker Uçkay

  2. Division of Infectious Diseases, Bretionneau Hospital, Tours University Hospitals, Tours, France

    Louis Bernard

  3. Service of Infectious Diseases, Geneva University Hospitals and Medical School, Geneva, Switzerland

    Christian Garzoni, Daniel Lew & Ilker Uçkay

Authors
  1. Maximilian Schindler
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Panayiotis Christofilopoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Blaise Wyssa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wilson Belaieff
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Garzoni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Louis Bernard
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Daniel Lew
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Pierre Hoffmeyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ilker Uçkay
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ilker Uçkay.

Additional information

The authors received no financial support, grants, or royalties and have no financial interests that could lead to a conflict of interest. All authors state that they have read and approved the manuscript. It has not been published elsewhere nor is it under consideration for publication elsewhere.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schindler, M., Christofilopoulos, P., Wyssa, B. et al. Poor performance of microbiological sampling in the prediction of recurrent arthroplasty infection. International Orthopaedics (SICOT) 35, 647–654 (2011). https://doi.org/10.1007/s00264-010-1014-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00264-010-1014-8

Keywords

Search

Navigation