Elsevier

The Journal of Arthroplasty

Volume 28, Issue 9, October 2013, Pages 1677-1680
The Journal of Arthroplasty

Incidence of Bacterial Contamination in Primary THA and Combined Hardware Removal: Analysis of Preoperative Aspiration and Intraoperative Biopsies

https://doi.org/10.1016/j.arth.2013.02.017Get rights and content

Abstract

Prior fracture surgery in the setting of subsequent arthroplasty may confer an increased risk of infection. The current authors retrospectively reviewed 122 patients from 2006 to 2010. Joint aspirations performed preoperatively in two of 52 patients revealed bacterial growth. Preoperative CRP levels were elevated in 22.8% with a mean value of 10.4 mg/L (range 5.5 to 33.3). Intra-operative cultures were performed in 109 patients, with a single patient sample exhibiting bacterial growth (0.9%). Preoperative aspiration showed a sensitivity of 1.0 and specificity of 0.98 (P < 0.039) for bacterial contamination. There was no postoperative periprosthetic infection noted. In conclusion the retrieval of internal fixation devices and total hip arthroplasty can be performed safely as a single stage procedure without significantly increasing the risk of periprosthetic infection.

Section snippets

Patients and Methods

Between January 2006 and December 2010 (inclusive), a total of 122 patients underwent a combined retrieval of hardware and total hip arthroplasty procedure as a single-stage operation. All patients with a previously known infection of the fixation device prior to THA were excluded. One patient died (unrelated cause) and 17 patients (13.8%) were lost to follow up. A telephone interview was conducted with all remaining patients, interviewed as to whether they had developed any postoperative

Results

There were a total of 122 patients that required a THA because of failed fracture fixation-devices or secondary to arthrosis post femoral osteotomies. Aspiration was performed in 52 patients (42.3%) with two patients (3.8%) exhibiting positive bacterial growth with Enterococcus faecalis and Staphylococcus epidermidis. Intraoperative samples were obtained in 109 patients (88.6%). In 108 patients, there was no bacterial growth. The patient with Staphylococcal growth in the aspirate had 5 negative

Discussion

Peri-prosthetic infection remains one of the most devastating complications in total hip arthroplasty. Independent of the level of bacterial contamination, the potential risk for deep infection of THA in the setting of concurrent hardware retrieval is not yet described fully in the current literature. With regard to primary THA amongst patients with hardware already in situ e.g. post ORIF for fractures or femoral osteotomy, in a study by Moussa and Anglen, it was reported that 53% of

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    The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.02.017.

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