Incidence of Bacterial Contamination in Primary THA and Combined Hardware Removal: Analysis of Preoperative Aspiration and Intraoperative Biopsies
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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Cited by (22)
Complications and survival of conversion to total hip arthroplasty after failed primary osteosynthesis compared to primary total hip arthroplasty in femoral neck fractures
2022, InjuryCitation Excerpt :Furthermore, we found no significant differences in the frequency of PJIs between the two groups. Although this result is in line with outcomes of several other studies [11,21], a systematic review and meta-analysis found an increased risk of PJIs after cTHA [14]. Regarding the latter it is of note that the rate of PJIs in the cTHA group in our study was more than twice the rate of PJIs in the pTHA group (3.9% versus 1.5%, respectively).
Total Hip Arthroplasty After Prior Acetabular Fracture: Infection Is a Real Concern
2020, Journal of ArthroplastyCitation Excerpt :Considering the potential complexity of the operation and risk for infection, some studies advocate that THA in patients with prior ORIF of acetabular fracture may be performed in 2 stages [21,35]. In cases with a high suspicion for infection such as those with a history of prior infection and those with elevated markers for infection [41,50], the hardware should be removed along with extensive debridement, bone resection, and placement of an antibiotic spacer during the initial surgery [44,51]. After a period of antibiotic therapy and with downtrending inflammatory markers, patients may then undergo second-stage surgery that involves removal of spacer, further surgical debridement and reimplantation [44,51].
Alternative Payment Models Should Risk-Adjust for Conversion Total Hip Arthroplasty: A Propensity Score-Matched Study
2018, Journal of ArthroplastyCitation Excerpt :Gittings et al [32] found that 18% of their series of 33 conversion THAs had an underlying infection, whereas a systematic literature review of 579 conversion THAs reported 25 deep SSIs (4.3%) [7]. It is advisable to perform preoperative serum C-reactive protein and erythrocyte sedimentation rate for conversion patients, and preoperative aspiration is recommended for patients with elevated serologies and/or history of prior deep SSI [33]. Intraoperative cultures and frozen section are also a consideration, particularly for those patients with elevated pretest probabilities (eg, history of prior deep SSI) [34].
Preoperative joint aspiration in the diagnosis of non-acute hip and knee prosthetic joint infections
2017, Medecine et Maladies InfectieusesCitation Excerpt :Preoperative joint aspiration (PJA) is recommended and plays a pivotal role in the algorithm of PJI diagnosis [9–12]. However, concordance with intraoperative cultures is inconsistent and ranges from 45 to 90% in the various studies [13–16]. PJA has a higher sensitivity and specificity in acute septic presentations [17–19].
The Conflict of Interest statement associated with this article can be found at http://dx.doi.org/10.1016/j.arth.2013.02.017.