Clinical outcomes of two-stage revision for chronic periprosthetic joint infection of the knee: culture-negative versus culture-positive

다국어 초록 (Multilingual Abstract)

The effect of negative culture on the treatment outcomes of chronic periprosthetic joint infection (PJI) is still controversial. The purpose of this study is to evaluate whether the outcomes of two-stage revision in culture-negative chronic PJI differ from those in culture-positive PJI.The patients who received two-stage revisions due to chronic PJI during the period between 2007 and 2017 were retrospectively reviewed. The culture-negative and culture-positive PJI group included 57 cases and 79 cases, respectively. The demographic data, as well as reoperation, mortality, reinfection, and failure rates of each group were evaluated.
There was a significant difference in reoperation rate between the two groups for the period from the first-stage surgery to the second-stage revision arthroplasty ( p = 0.045). The reoperation rate of the culture-positive group was 25.3% (20/79) whereas that of the culture-negative group was 10.5% (6/57). Among the 136 PJI cases, 97 cases (71.3%) received reimplantation surgery (culture-negative group, 43 cases; culture-positive group, 54 cases). No significant difference was noted between the culture-negative and culture-positive groups with respect to the number of cases that did not undergo reimplantation surgery and the reoperation, reinfection, mortality, and failure rates after two-stage surgery ( p > 0.05, all parameters).
The culture outcome had no significant effect on the outcome of the two-stage revision in patients with chronic PJI. The reoperation rate after first-stage surgery was significantly higher in the culture-positive group, but the overall failure rate did not significantly differ in both the groups. The presence of a negative culture might be a good prognostic factor for chronic PJI.

참고문헌 (Reference)

1 Sharkey PF, "Why are total knee arthroplasties failing today--has anything changed after 10 years?" 29 (29): 1774-1778, 2014

2 이용석, "Two­-Stage Reimplantation in Infected Total Knee Arthroplasty" 대한슬관절학회 30 (30): 107-114, 2018

3 Petis SM, "Twostage exchange protocol for periprosthetic joint infection following total knee arthroplasty in 245 knees without prior treatment for infection" 101 (101): 239-249, 2019

4 Li H, "Two-stage revisions for culture-negative infected total knee arthroplasties : a five-year outcome in comparison with one-stage and two-stage revisions for culture-positive cases" 22 (22): 306-312, 2017

5 Ibrahim MS, "Two-stage revision for the culturenegative infected total hip arthroplasty: a comparative study" 100-B (100-B): 3-8, 2018

6 Bejon P, "Two-stage revision for prosthetic joint infection : predictors of outcome and the role of reimplantation microbiology" 65 (65): 569-575, 2010

7 Kuzyk PR, "Two-stage revision arthroplasty for management of chronic periprosthetic hip and knee infection : techniques, controversies, and outcomes" 22 (22): 153-164, 2014

8 Lichstein P, "Treatment of periprosthetic knee infection with a two-stage protocol using static spacers" 474 (474): 120-125, 2016

9 Kim YH, "The outcome of infected total knee arthroplasty : culture-positive versus culture-negative" 135 (135): 1459-1467, 2015

10 Gomez MM, "The fate of spacers in the treatment of periprosthetic joint infection" 97 (97): 1495-1502, 2015

11 Bozic KJ, "The epidemiology of revision total knee arthroplasty in the United States" 468 (468): 45-51, 2010

12 Parvizi J, "The 2018 definition of periprosthetic hip and knee infection : an evidence-based and validated criteria" 33 (33): 1309-1314, 2018

13 Azeem Tariq Malik, "Seasonal Influence on Postoperative Complications after Total Knee Arthroplasty" 대한슬관절학회 30 (30): 42-49, 2018

14 박형진, "Safety of Temporary Use of Recycled Autoclaved Femoral Components in Infected Total Knee Arthroplasty: Confirming Sterility Using a Sonication Method" 대한정형외과학회 10 (10): 427-432, 2018

15 Malekzadeh D, "Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection" 468 (468): 2039-2045, 2010

16 Choi HR, "Periprosthetic joint infection with negative culture results : clinical characteristics and treatment outcome" 28 (28): 899-903, 2013

17 Kapadia BH, "Periprosthetic joint infection" 387 (387): 386-394, 2016

18 Parvizi J, "New definition for periprosthetic joint infection : from the Workgroup of the Musculoskeletal Infection Society" 469 (469): 2992-2994, 2011

19 Haleem AA, "Mid-term to long-term followup of two-stage reimplantation for infected total knee arthroplasty" 428 : 35-39, 2004

20 Hakim J, "Long-term outcome of total knee arthroplasty in patients with morbid obesity" 44 (44): 95-104, 2018

21 Reisener M, "Do culture-negative periprosthetic joint infections have a worse outcome than culture-positive periprosthetic joint infections? A systematic review and meta-analysis" 2018

22 Osmon DR, "Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America" 56 (56): e1-e25, 2014

23 Parvizi J, "Definition of periprosthetic joint infection" 29 (29): 1331-, 2014

24 Berbari EF, "Culture-negative prosthetic joint infection" 45 (45): 1113-1119, 2007

25 Huang R, "Culture-negative periprosthetic joint infection does not preclude infection control" 470 (470): 2717-2723, 2012

26 Tan TL, "Culture-negative periprosthetic joint infection : an update on what to expect" 3 (3): e0060-, 2018

27 Kim YH, "Comparison of infection control rates and clinical outcomes in culture-positive and culture-negative infected total-knee arthroplasty" 12 (12): S37-S43, 2015

28 Young­-Joon Choi, "Comparison of Revision Rates Due to Aseptic Loosening between High-­Flex and Conventional Knee Prostheses" 대한슬관절학회 30 (30): 161-166, 2018

29 Wang J, "Comparable outcome of culturenegative and culture-positive periprosthetic hip joint infection for patients undergoing two-stage revision" 42 (42): 469-477, 2018

30 정희진, "Clinical Guidelines for the Antimicrobial Treatment of Bone and Joint Infections in Korea" 대한감염학회 46 (46): 125-138, 2014

31 Della Valle C, "American Academy of Orthopaedic Surgeons clinical practice guideline on: the diagnosis of periprosthetic joint infections of the hip and knee" 93 (93): 1355-1357, 2011

32 Rhee SJ, "A comparison of long-term outcomes of computer-navigated and conventional total knee arthroplasty: a meta-analysis of randomized controlled trials" 101 (101): 1875-1885, 2019

33 윤홍권, "A Review of the Literature on Culture­Negative Periprosthetic Joint Infection: Epidemiology, Diagnosis and Treatment" 대한슬관절학회 29 (29): 155-164, 2017