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Cutibacterium positive cultures in total joint arthroplasty: a comparison of the hip, knee, and shoulder

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Abstract

Purpose

Cutibacterium spp. (formerly Propionibacterium) is a slow growing, Gram-positive, anaerobic bacteria and is an emerging clinical entity in prosthetic joint infection (PJI). This study compares the presentation, surgical management, and post-operative antibiotic therapy of patients with positive intraoperative cultures during revision total joint arthroplasty (TJA) of the hip, knee, and shoulder.

Methods

This was a retrospective cohort study of patients from 2014 to 2020 of 57 revision TJAs (27 total hip arthroplasty (THA), 17 total shoulder arthroplasty (TSA), and 13 total knee arthroplasty (TKA)) with intraoperative cultures positive for Cutibacterium at a tertiary academic centre. Patient demographics, pre-operative labs, radiographs, and aspirate results were collected. Intraoperative data was reviewed. Post-operative antibiotic therapy and repeat infections were recorded. Data was compared with univariate analyses.

Results

There was no significant difference in pre-operative lab values between the cohorts. All cohorts had > 58% radiographic lucency. Revision TSA patients had significantly fewer pre-operative aspirates. Six patients undergoing revision THA, three TKA and one TSA had a repeat infection requiring further surgery. Four in the THA cohort and one in the TKA cohort with repeat infections did not receive prolonged antibiotic therapy.

Conclusion

Cutibacterium is an infectious agent that can present in an indolent fashion after TJA. It commonly causes progressive radiographic lucency. The workup and post-operative management differs in the hip, knee, and shoulder, which is likely due to existing literature guiding physician practice. In all joints, Cutibacterium is a virulent pathogen that can cause repeat infections requiring surgical treatment.

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Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA

    Niall Cochrane, Patrick Kelly, Thorsten Seyler, Christopher Klifto & William Jiranek

  2. School of Medicine, Duke University Medical Center, Durham, NC, USA

    Billy Kim

  3. Department of Infectious Diseases, Duke University Medical Center, Durham, NC, USA

    Jessica Seidelman

Authors
  1. Niall Cochrane
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  2. Billy Kim
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  3. Patrick Kelly
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  7. William Jiranek
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Niall Cochrane, Billy Kim, Patrick Kelly, and Jessica Seidelman. The first draft of the manuscript was written by Niall Cochrane, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Patrick Kelly.

Ethics declarations

Ethical approval

This is a retrospective cohort study that was approved by the Duke University Institutional Review Board.

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This is not applicable.

Competing interests

Authors Niall Cochrane, Billy Kim, Patrick Kelly and Jessica Seidelman have no relevant financial or nonfinancial interests to disclose. William Jiranek has stock options in Biomech LLC and receives royalties from Depuy. Dr. Jiranek is also an active member of the Hip Society and American Association of Hip and Knee Surgeons. Dr. Seyler receives royalties from Total Joint Orthopedics, Inc., Pattern Health and Restor3d. He is a paid consultant for Smith and Nephew, Total Joint Orthopedics, Inc. and Heraeus, He receives research support from Next Science and Zimmer and financial material support from Lippincott Williams and Wilkins. He is an active member of the American Association of Hip and Knee Surgeons and the Musculoskeletal Infection Society. Dr. Klifto is a paid consultant for Integra and Additive Orthopedics. He gives paid presentations for Integra. He has stock options in GE Healthcare, Johnson and Johnson, Merck, and Pfizer.

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Institution at which work was performed: Duke University Medical Center.

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Cochrane, N., Kim, B., Kelly, P. et al. Cutibacterium positive cultures in total joint arthroplasty: a comparison of the hip, knee, and shoulder. International Orthopaedics (SICOT) 47, 1939–1946 (2023). https://doi.org/10.1007/s00264-023-05804-y

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  • DOI: https://doi.org/10.1007/s00264-023-05804-y

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