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Study Investigates Necessity for Intraoperative Cultures Following Periprosthetic Joint Infection

For Immediate Release
November 7, 2020

Dallas –A presentation at the 30th AAHKS Annual Meeting reported on a study to determine the prevalence of discordance between preoperative synovial fluid and intraoperative tissue cultures in total joint arthroplasty (TJA) patients diagnosed with periprosthetic joint infection (PJI).

The research team studied 363 total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients diagnosed with PJI following primary surgery. All patients had positive preoperative intra-articular synovial fluid and intraoperative tissue cultures at time of revision surgery. Patients were divided into two categories: concordant and discordant. Discordant cultures were defined as a difference in at least one microorganism between preoperative aspiration and intraoperative tissue cultures.

Lead author, K. Keely Boyle, MD, and co-authors, Milan Kapadia, BS, Michael Henry, MD, Andy O. Miller, MD, and Alberto V. Carli, MD, FRCSC, found concordance in 76.6% of patients. Culture discordance occurred in 23.4% of patients. The study also reported that MRSA and MSSA demonstrated the highest concordance rates (100%), with the strongest diagnostic performance for predicting intraoperative cultures. C. acnes demonstrated the lowest concordance and had a poor diagnostic performance with low sensitivity, specificity, PPV and NPV.

The investigators concluded that “while the majority of aspiration and tissue cultures in PJI are concordant it varies based on bacterial species. For accurate pathogen identification, both aspiration and tissue cultures should be collected.” Further investigations are needed to elucidate the potential merit of initiating preoperative antibiotics in the setting of PJI for bacteria, such as MRSA, with the highest concordance rates.

Dr. Boyle received the 2020 James A. Rand Young Investigator’s Award for this work. Abstract: http://meeting.aahks.org/wp-content/uploads/20_award-rand-boyle.pdf

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About the American Association of Hip and Knee Surgeons Established in 1991, the mission of AAHKS is to advance hip and knee patient care through education and advocacy. AAHKS has a membership of over 4,000 surgeons and other hip and knee health care professionals.

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