Top

Published in:

01-04-2020 | Hip Dislocation | Original Paper

Periprosthetic joint infection in aseptic total hip arthroplasty revision

Authors: Guillaume Renard, Jean-Michel Laffosse, Meagan Tibbo, Thibault Lucena, Etienne Cavaignac, Jean-Louis Rouvillain, Philippe Chiron, Mathieu Severyns, Nicolas Reina

Published in: International Orthopaedics | Issue 4/2020

Abstract

Purpose

There is no consensus regarding systematic screening for infection in aseptic revision total hip arthroplasty (THA). The rationale for systematic intra–operative samples is to increase the sensitivity of latent infections detection, which may require specific treatment. However, the incidence of occult infection in revision THAs is not precisely known. As such, the aim of the study was to evaluate the incidence of occult infection in presumed aseptic revision THAs and identify associated risk factors.

Method

Bacteriological samples from 523 aseptic THA revisions performed for five years were analyzed. Revisions performed for periprosthetic joint infection (PJI) or clinical suspicion of PJI were excluded. Microbiological cultures were performed using tissue samples in 505 cases (97%), synovial fluid in blood culture vials in 158 (30%), and in dry tubes in 263 (50%). Implants were sent for sonication in 12 cases (2.6%). The mean number of microbiological samples per patient was 3.6 (range, 1–15). Histology samples were collected for 300 patients (57%).

Results

The incidence of occult infection was 7% (36 cases) and contamination 8% (42 cases). Among occult infections, the primary reasons for revision were dislocation (42%), aseptic loosening (25%), fracture (19%), and others (14%). The infection rate in the dislocation group was significantly higher than that of other reasons for revision (p < 0.001). Among the patients determined with PJI, the revision THA was performed less than a year after primary in 19 (53%).

Conclusion

The incidence of occult PJI justifies systematic intraoperative sampling. A short time between primary arthroplasty and revision or an early postoperative dislocation is a factor to suspect infections.

Reina N, Delaunay C, Chiron P, Ramdane N, Hamadouche M (2013) Infection as a cause of primary total hip arthroplasty revision and its predictive factors. Orthop Traumatol: Surg Res 99:555–561. https://doi.org/10.1016/j.otsr.2013.07.001 CrossRef

Delaunay C, Hamadouche M, Girard J, Duhamel A (2013) What are the causes for failures of primary hip arthroplasties in France? Clin Orthop Relat Res 471:3863–3869. https://doi.org/10.1007/s11999-013-2935-5 CrossRefPubMedPubMedCentral

Zimmerli W, Trampuz A, Ochsner PE (2004) Prosthetic-joint infections. N Engl J Med 351:1645–1654. https://doi.org/10.1056/NEJMra040181 CrossRef

Parvizi J, Zmistowski B, Berbari EF, Bauer TW, Springer BD, Della Valle CJ et al (2011) New definition for periprosthetic joint infection: from the workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res 469:2992–2994. https://doi.org/10.1007/s11999-011-2102-9 CrossRefPubMedPubMedCentral

Cazanave C, Greenwood-Quaintance KE, Hanssen AD, Karau MJ, Schmidt SM, Gomez Urena EO et al (2013) Rapid molecular microbiologic diagnosis of prosthetic joint infection. J Clin Microbiol 51:2280–2287. https://doi.org/10.1128/JCM.00335-13 CrossRefPubMedPubMedCentral

Rak M, KavčIč M, Trebše R, CőR A (2016) Detection of bacteria with molecular methods in prosthetic joint infection: sonication fluid better than periprosthetic tissue. Acta Orthop 87:339–345. https://doi.org/10.3109/17453674.2016.1165558 CrossRefPubMedPubMedCentral

Kosashvili Y, Backstein D, Safir O, Lakstein D, Gross AE (2011) Dislocation and infection after revision total hip arthroplasty: comparison between the first and multiply revised total hip arthroplasty. J Arthroplast 26:1170–1175. https://doi.org/10.1016/j.arth.2011.04.022 CrossRef

Klouche S, Leonard P, Zeller V, Lhotellier L, Graff W, Leclerc P et al (2012) Infected total hip arthroplasty revision: one- or two-stage procedure? Orthop Traumatol Surg Res 98:144–150. https://doi.org/10.1016/j.otsr.2011.08.018 CrossRefPubMed

Osmon DR, Berbari EF, Berendt AR, Lew D, Zimmerli W, Steckelberg JM et al (2013) Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis 56:e1–e25. https://doi.org/10.1093/cid/cis803

10.

Saleh A, Guirguis A, Klika AK, Johnson L, Higuera CA, Barsoum WK (2014) Unexpected positive intraoperative cultures in aseptic revision arthroplasty. J Arthroplast 29:2181–2186. https://doi.org/10.1016/j.arth.2014.07.010 CrossRef

11.

Dupont JA (1986) Significance of operative cultures in total hip arthroplasty. Clin Orthop Relat Res 211:122–127

12.

Barrack RL, Aggarwal A, Burnett RSJ, Clohisy JC, Ghanem E, Sharkey P et al (2007) The fate of the unexpected positive intraoperative cultures after revision total knee arthroplasty. J Arthroplast 22:94–99. https://doi.org/10.1016/j.arth.2007.03.029 CrossRef

13.

Wee AT, Morrey BF, Sanchez-Sotelo J (2013) The fate of elbows with unexpected positive intraoperative cultures during revision elbow arthroplasty. J Bone Joint Surg Am 95:109–116. https://doi.org/10.2106/JBJS.K.00121 CrossRefPubMed

14.

Berend KR, Lombardi AV, Adams JB (2007) Unexpected positive intraoperative cultures and gram stain in revision total hip arthroplasty for presumed aseptic failure. Orthopedics 30:1051–1053CrossRef

15.

de Jong L, Klem TM a L, Kuijper TM, Roukema GR (2017) Factors affecting the rate of surgical site infection in patients after hemiarthroplasty of the hip following a fracture of the neck of the femur. Bone Joint J 99-B:1088–1094. https://doi.org/10.1302/0301-620X.99B8.BJJ-2016-1119.R1 CrossRefPubMed

16.

Font-Vizcarra L, Zumbado A, García S, Bosch J, Mensa J, Soriano A (2011) Relationship between haematoma in femoral neck fractures contamination and early postoperative prosthetic joint infection. Injury 42:200–203. https://doi.org/10.1016/j.injury.2010.09.006 CrossRefPubMed

17.

Evans PE (1981) Septic dislocation of the hip after internal fixation of trochanteric fractures. Injury 13:185–187CrossRef

18.

Mühlhofer HML, Knebel C, Pohlig F, Feihl S, Harrasser N, Schauwecker J et al (2018) Synovial aspiration and serological testing in two-stage revision arthroplasty for prosthetic joint infection: evaluation before reconstruction with a mean follow-up of twenty seven months. Int Orthop 42:265–271. https://doi.org/10.1007/s00264-017-3700-2 CrossRef

19.

DeHaan A, Huff T, Schabel K, Doung Y-C, Hayden J, Barnes P (2013) Multiple cultures and extended incubation for hip and knee arthroplasty revision: impact on clinical care. J Arthroplast 28:59–65. https://doi.org/10.1016/j.arth.2013.03.037 CrossRef

20.

Davis N, Curry A, Gambhir AK, Panigrahi H, Walker CR, Wilkins EG et al (1999) Intraoperative bacterial contamination in operations for joint replacement. J Bone Joint Surg (Br) 81:886–889CrossRef

21.

Abdelaziz H, Zahar A, Lausmann C, Gehrke T, Fickenscher H, Suero EM et al (2018) High bacterial contamination rate of electrocautery tips during total hip and knee arthroplasty. Int Orthop 42:755–760. https://doi.org/10.1007/s00264-018-3822-1 CrossRefPubMed

22.

Kliushin NM, Ermakov AM, Malkova TA (2017) Chronic periprosthetic hip infection: micro-organisms responsible for infection and re-infection. Int Orthop 41:1131–1137. https://doi.org/10.1007/s00264-016-3341-x CrossRefPubMed

23.

Rothenberg AC, Wilson AE, Hayes JP, O’Malley MJ, Klatt BA (2017) Sonication of arthroplasty implants improves accuracy of periprosthetic joint infection cultures. Clin Orthop Relat Res 475:1827–1836. https://doi.org/10.1007/s11999-017-5315-8 CrossRefPubMedPubMedCentral

24.

Padgett DE, Silverman A, Sachjowicz F, Simpson RB, Rosenberg AG, Galante JO (1995) Efficacy of intraoperative cultures obtained during revision total hip arthroplasty. J Arthroplast 10:420–426. https://doi.org/10.1016/S0883-5403(05)80140-8 CrossRef

25.

Boot W, Moojen DJF, Visser E, Lehr AM, de WTS, van HG et al (2015) Missed low-grade infection in suspected aseptic loosening has no consequences for the survival of total hip arthroplasty: 173 patients followed for 6 to 9 years. Acta Orthop 86:678–683. https://doi.org/10.3109/17453674.2015.1086942 CrossRefPubMedPubMedCentral

26.

Bauer S, Bouldouyre M-A, Oufella A, Palmari P, Bakir R, Fabreguettes A et al (2012) Impact of a multidisciplinary staff meeting on the quality of antibiotherapy prescription for bone and joint infections in orthopedic surgery. Med Mal Infect 42:603–607. https://doi.org/10.1016/j.medmal.2012.09.005 CrossRefPubMed

27.

Ji B, Zhang X, Xu B, Ren J, Guo W, Mu W et al (2018) The fate of immunocompromised patients in the treatment of chronic periprosthetic joint infection: a single-centre experience. Int Orthop 42:487–498. https://doi.org/10.1007/s00264-018-3763-8 CrossRefPubMed

Title: Periprosthetic joint infection in aseptic total hip arthroplasty revision
Authors: Guillaume Renard
Jean-Michel Laffosse
Meagan Tibbo
Thibault Lucena
Etienne Cavaignac
Jean-Louis Rouvillain
Philippe Chiron
Mathieu Severyns
Nicolas Reina
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Hip Dislocation
Joint Infection
Hip-TEP
Hip-TEP
Published in: International Orthopaedics / Issue 4/2020
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-019-04366-2

At a glance: The STEP trials

Springer Medicine

Periprosthetic joint infection in aseptic total hip arthroplasty revision

Abstract

Purpose

Method

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Method

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 4/2020

Morphometric analysis of the anterior column of the acetabulum and safety of intramedullary screw fixation for its fractures in Indian population: a preliminary report

Over the top anterior cruciate ligament reconstruction in patients with open physes: a long-term follow-up study

Minimal under-correction gives better outcomes following total knee arthroplasty in severe varus knees—myth or reality?—analysis of one hundred sixty two knees with varus greater than fifteen degrees

New landmarks for ideal positioning of syndesmotic screw: a computerised tomography based analysis and radiographic simulation

Femoral bone remodeling after short-stem total hip arthroplasty: a prospective densitometric study

Megaprosthesis in distal femur non-unions in elderly patients—experience from twenty-four cases: a letter to editor