Unexpected positive intraoperative culture during supposed aseptic hip revision: Antibiotherapy is an effective and safe treatment. About 50 cases.

Abstract

Background: The management of periprosthetic joint infection (PJI) in revision total hip arthroplasty (rTHA) with unsuspected positive intraoperative cultures (UPC) is not well codified. There are conflicting results in the literature. No study reported the long-term outcomes between single or both component rTHA with UPC. The aim of this study was to compare the overall survival rate of single component revision to total in case of rTHA with UPC using an institutional registry database. The reinfection-free survival rate was assessed as secondary outcomes.

Methods: Patients were selected from a PJI institutional registry of THA between March 2003 and May 2020. Fifty rTHA with UPC were finally included in the study: 26 in the both component revision group and 24 in the single component revision group. The mean age of the patients was 64.8 years (range: 30.6; 88.2), 36% (18/50) of the patients were women and with a mean body mass index (BMI) of 27.6 Kg/m2 (range: 19.6; 39.5). Kaplan-Meier analyses were performed to compare overall survival rate between groups.

Results: The overall survival rate in our series of rTHA with UPC was 70.0% [56.1%-87.2%] at 10 years. Fourteen re-interventions were carried out during the follow-up period (28.0%, 14/50). There was no significant difference between groups (61.4% vs. 79.3% at 10 years, respectively in both and single rTHA, p = 0.76). At the last follow-up, three infections were observed (6%, 3/50): 1 relapse (33.4%) and 2 new infections (66.6%). There was no significant difference between groups (83.2% vs. 100.0% at 10 years, respectively in both and single component rTHA, p = 0.08).

Conclusion: Antibiotic therapy alone for UPC in a single component revision of a presumed aseptic THA is a safe and effective treatment. Therapeutic study level of evidence, level III retrospective study.