Multiple deep tissue cultures in primary total hip arthroplasty: prognostic value for periprosthetic infection

Abstract

Background: The risk of infection after total hip replacement (THR) is significant, with negative impact on quality of life and high costs. Bacteria can contaminate the surgical site despite aseptic techniques; however, there is debate regarding the benefit of identifying bacteria during the primary procedure. Although taking multiple samples for culture is a well-established practice in revision arthroplasty, doing so in primary cases remains controversial. We aimed to investigate whether there is a prognostic value in the culture of samples taken during primary THR, seeking a correlation between the positivity of the cultures and subsequent prosthetic joint infection (PJI). Methods: Deep samples (capsule, femoral and acetabular bone) were collected from 426 patients undergoing elective primary THR. Follow-up was at least 3 years. Microbiological profiles of cultures were analysed. Patient data were reviewed for the identification of risk factors presumably associated with a higher risk of PJI. Results: 54 surgeries (12.6%) had positive cultures. 16 cases (3.8%) developed infection, of which 5 had a positive culture in the primary surgery. Infection rate was 9.3% in patients with positive culture and 3% in those with negative culture ( p < 0.05), with an odds ratio of 3.34 (95% CI, 1.09–10.24). Patients with previous hip surgery had an infection rate of 8.5%, compared to 2.9% in patients with no previous surgery ( p < 0.05). Conclusions: Routinely harvesting microbiologic samples in primary THR is not justified, as it has no consequence in clinical decision for most patients. It might be recommended in selected cases that are suspected to be at high risk for infection, especially previously operated patients (conversion arthroplasty).

Unexpected positive intraoperative cultures (UPIC) at index osseointegration do not lead to increased postoperative infectious events

“…When performing elective reconstructive orthopedic surgery involving implantation of large permanent metal implants, it is generally considered optimal to have a patient and local wound environment without infection in order to optimize wound healing and infection risks. There is substantial literature investigating the significance of unexpected positive intraoperative cultures (UPIC) identified during surgery for primary total hip, knee, and shoulder replacement (Zmistowski et al, 2021;Wong et al, 2018;Jonsson et al, 2014;Ferro et al, 2020), revision total joint implantation (Padegimas et al, 2017;Hipfl et al, 2021;Pérez-Prieto et al, 2021), and open fractures (Agrawal et al, 2013).…”