gms | German Medical Science

Introduction: The prevalence of unexpected positive cultures (UPC) in aseptic revision surgery of the joint with a prior septic revision in the same joint remain unknown. The purpose of this study was to determine the prevalence of UPC in that specific group. As secondary outcome, we explore risk factors for UPC.

Methods: This retrospective study includes patients with an aseptic revision total hip/knee arthroplasty procedure with a prior septic revision in the same joint. Patients with less than three microbiology samples, without joint aspiration or with aseptic revision surgery performed <3 weeks after a septic revision were excluded. UPC was defined as a single positive culture in a revision that the surgeon had classified as aseptic according to the 2018 International Consensus Meeting.

Results and conclusion: After excluding 47, a total of 92 patients were analyzed, 52 males and 40 females, with a mean age of 70 years (±10.6). There were 66 (71.7%) hips and 26 (28.3%) knees. The mean time between revisions was 83 months (±89). We identified 11 (12%) UPC and in 3 cases there was a concordance of the germ compared to the previous septic surgery.

There were no differences for UPC between hips/knees (p=0.282), diabetes (p=0.701), immunosuppression (p=0.252), previous one-stage or two-stages (p=0.316), causes for the aseptic revision (p=0.429) and time after the septic revision (p=0.773).

The prevalence of UPC in this specific group was like those reported in the literature for aseptic revisions. More studies are needed to better interpret the results in those high-risk group.