Unexpected Positive Cultures in Presumed Aseptic Revision Total Hip Arthroplasty: A Systematic Review and Meta-Analysis of Incidence, Risk Factors, Management, and Outcomes Publisher



Mirghaderi P¹ ; Esmaeili S² ; Pouramini A¹ ; Azarboo A³ ; Ghaseminejadraeini A³ Show Affiliations
Source: JBJS Reviews Published:2024

Abstract

Background:Occult infection may be the underlying cause for a number of presumed aseptic revision total hip arthroplasty (THA) because certain periprosthetic joint infections (PJIs) can remain asymptomatic for years and present with component loosening and weight-bearing pain in the absence of any clinical signs and symptoms of infection. There is no consensus in the literature regarding the interpretation, treatment, and clinical outcomes of unexpected positive cultures (UPCs) during aseptic revision THA.Methods:Four main databases were searched between January 2000 and January 2023. By pooling the UPC rates from the included studies, an overall UPC rate was calculated. We examined variables reported in more than 2 articles for possible associations with UPC.Results:Twenty-two articles were included. UPC prevalence in presumed aseptic revision THA (7,449 cases) was 15.06% (95% confidence interval [CI]: 11.05-20.19). In regards to unexpected culture positivity and culture method or medium, conventional cultures reported a 17.2% incidence, implant sonication 19.6%, and polymerase chain reaction 12.6%. Coagulase-negative staphylococci and Cutibacterium acnes were the most common pathogens (prevalence [95% CI]: 54.4% [44.9%-63.6%] and 9.1% [5.1%-15.8%]). Polymicrobial cultures were observed in 11.6% [7.318.0%] of UPCs. UPC cases were found to include more males than culture-negative THA patients (odds ratio [OR] [95% CI]: 1.36 [1.02-1.83]). Age, body mass index, American Society of Anesthesiology, loosening, previous revision, diabetes mellitus, and rheumatoid arthritis did not show a significant association with UPC incidence (p > 0.05). The all-cause revision and PJI rate were significantly higher in those having an UPC (OR [95% CI]: 1.40 [1.09-1.80], p = 0.009 and OR [95% CI]: 1.97 [1.22-3.18], p = 0.005).Conclusions:Isolating organisms through intraoperative culture is common in patients undergoing aseptic revision THA. This diagnostic step is crucial to properly investigate and exclude the possibility of an occult PJI. It should be noted that our results are prone to limitations of the included studies; therefore, well-designed prospective research is highly suggested.Level of Evidence:Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2024 By The Journal of Bone and Joint Surgery, Incorporated.