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Clinical Orthopaedics and Related Research®
Published in: Clinical Orthopaedics and Related Research® 11/2013

01-11-2013 | Clinical Research

Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection

Authors: María Eugenia Portillo, MD, PhD, Margarita Salvadó, MD, PhD, Albert Alier, MD, Lluisa Sorli, MD, Santos Martínez, MD, Juan Pablo Horcajada, MD, PhD, Lluis Puig, MD, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 11/2013

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Abstract

Background

The outcome of revision surgery depends on accurate determination of the cause of prosthesis failure because treatment differs profoundly among aseptic loosening, mechanical failure, and prosthetic joint infections (PJI).

Questions/purposes

We sought to determine (1) the predictive role of the interval from primary to revision surgery in determining the reason for prosthesis failure of a hip, knee, shoulder, or elbow arthroplasty, and (2) whether positive cultures during revision surgery for aseptic loosening were associated with shorter event-free survival of the prosthesis.

Methods

All patients undergoing revision surgery between July 2010 and January 2012 were included in a prospective cohort of 112 patients, and were classified as having had failure from aseptic loosening (56%), mechanical failure (15%), or PJI (29%). To make the diagnosis of PJI, at surgery we used a standardized enhanced diagnostic approach in all patients including sampling of five periprosthetic tissue specimens, sonication of removed prosthetic components, prolonged incubation of aerobic and anaerobic cultures, and multiplex PCR of sonication fluid in aseptic loosening cases. Kaplan-Meier survival and Cox proportional hazards regression analysis were performed.

Results

The median time from primary to revision surgery was (p < 0.001) longer for patients with aseptic loosening (7.8 years) than for patients with mechanical failure (1.6 years) or PJI (2 years). No difference in the time to revision was observed for patients with aseptic loosening with positive or negative microbiological cultures (p = 0.594). Propionibacterium acnes was cultured below the established microbiological criteria for positivity in 12 (19%) procedures that had been presumed to have been revisions for aseptic loosening.

Conclusions

PJI should be considered in all revisions performed within 2 years of implantation even in the absence of clinical or laboratory findings suggestive for infection. However, the growth of low-virulence microorganisms below the cut-off in revisions for apparent aseptic loosening is not associated with early prosthesis failure.

Level of Evidence

Level II, diagnostic study. See the Instructions for Authors for a complete description of levels of evidence.
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Metadata
Title
Prosthesis Failure Within 2 Years of Implantation Is Highly Predictive of Infection
Authors
María Eugenia Portillo, MD, PhD
Margarita Salvadó, MD, PhD
Albert Alier, MD
Lluisa Sorli, MD
Santos Martínez, MD
Juan Pablo Horcajada, MD, PhD
Lluis Puig, MD, PhD
Publication date
01-11-2013
Publisher
Springer US
Published in
Clinical Orthopaedics and Related Research® / Issue 11/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-013-3200-7

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