ICJR Interviews: The Risk of Revision Failure with a Single Positive Culture

    The orthopaedic literature is largely silent on the significance of a positive tissue or synovial fluid culture at the second stage of a 2-stage exchange for periprosthetic joint infection (PJI), primarily because it is a rare occurrence.

    As a result many surgeons will discount a single positive culture as a lab contaminant and take no further treatment steps.

    But a study from The Rothman Institute in Philadelphia, Pennsylvania, has shown that even a single positive culture should be taken seriously.

    Timothy Tan, MD, and his colleagues looked at tissue and synovial fluid cultures on 267 patients who had undergone 2-stage exchange arthroplasty due to a PJI.

    They found at least a single positive culture in 12.4% of patients, and at 1-year follow-up, the treatment failure rate was 45%. The failure rate was not significantly different between patients with a single positive culture and those with 2 or more positive cultures.

    Dr. Tan said patients with a higher Charlson comorbidity score and those who had been infected with an antibiotic-resistant organism were at greatest risk for treatment failure.

    Click the image above to hear Dr. Tan discuss the results and implications of the study, “Positive Cultures during Reimplantation Increase the Risk of Subsequent Failure” (Poster 188), which was presented at the 2016 Annual Meeting of the American Academy of Orthopaedic Surgeons in Orlando.

    Producer: Susan Doan Johnson; Director: Michael Bugera; Post Production: Charles J. Maynard