Unexpected positive intraoperative cultures and gram stain in revision total hip arthroplasty for presumed aseptic failure

Orthopedics
Keith R BerendJoanne B Adams

Abstract

No method to determine aseptic versus septic failure provides 100% sensitivity and specificity. An algorithmic approach nears 100%. In cases where preoperative suspicion is low and the septic workup is negative, intraoperative cultures can still be positive. The importance of unexpected positive results is unknown. We investigated the incidence of positive intraoperative gram stain and cultures in 103 revision total hips. Seven positive gram stains or cultures were observed. No subsequent infections were observed. All positive results were treated as significant. Unexpected positive culture results or gram stain in an otherwise low suspicion revision total hip arthroplasty should be treated as significant. It is now recommended that multiple cultures be obtained and that a single isolate may not be a significant finding.

Citations

Mar 31, 2016·European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society·Grant D ShifflettAlexander P Hughes
Jun 27, 2019·International Orthopaedics·Guillaume RenardNicolas Reina
Nov 20, 2015·BioMed Research International·J T KempthorneG Hooper
Jul 18, 2018·Spine·Michael E SteinhausAlexander P Hughes
May 12, 2021·The Journal of Bone and Joint Surgery. American Volume·Michael E NeufeldEdward M Vasarhelyi

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