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Outcomes of patients with unexpected diagnosis of infection at total hip or total knee arthroplasty revisions

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Abstract

Purpose

The pre-operative differential diagnosis between periprosthetic joint infections (PJIs) and aseptic failure is challenging particularly in low virulence and biofilm-related infections. This study aimed to assess the incidence and survival of patients with unexpected PJIs in a presumed aseptic revision of total hip (THA) and knee (TKA) arthroplasties.

Methods

A retrospective analysis of a prospective cohort of patients was performed with 295 patients undergoing THA (n = 241) or TKA (n = 54) revision for presumed aseptic causes. Patients were diagnosed with unexpected PJI taking into account leukocyte count in the synovial fluid, sonicate, synovial culture, and tissue cultures of samples collected during surgery. The primary endpoint was the infection-free implant survival rate at theone year follow-up.

Results

The unexpected PJIs were 60 out of 295 (20.3%), whereas 235 (79.7%) were aseptic revisions. In the unexpected PJI group, 6 (11.1%) patients underwent knee revision and 54 (22.4%) hip revision. At the one year follow-up, one patient (1.6%) in the unexpected PJI group and 3 (1.3%) in the aseptic group (p = 1.0) failed for infection. The infection-free implant survival rate at the one year follow-up was 98.3% (C.I. 95%, 94.9–99.9%) for the unexpected PJI group and 98.7% (C.I. 95%, 97.3–99.9%) (p = 0.82) for the aseptic group.

Conclusion

The incidence of unexpected PJIs in a presumed aseptic revision of THAs and TKAs has been previously underestimated. The infection-free implant survival rate at the one year follow-up in patients with unexpected PJIs was not significantly lower compared with patients undergoing aseptic revision.

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Authors and Affiliations

  1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090, Milan, Italy

    Mattia Loppini, Alessandro Pisano & Marco Di Maio

  2. IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy

    Mattia Loppini, Francesco La Camera, Maddalena Casana & Guido Grappiolo

  3. Fondazione Livio Sciutto Onlus, Università Degli Studi Di Genova, Campus Savona, Via Magliotto 2, 17100, Savona, Italy

    Francesco La Camera & Guido Grappiolo

Authors
  1. Mattia Loppini
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  2. Alessandro Pisano
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  3. Marco Di Maio
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  4. Francesco La Camera
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  5. Maddalena Casana
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  6. Guido Grappiolo
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Contributions

All the authors of the present manuscript (1) significantly contributed to the conception or design of the study or the collection, analysis, or interpretation of the data; (2) drafted the work or revised it critically for important intellectual content; and (3) approved the final version for the publication.

Corresponding author

Correspondence to Mattia Loppini.

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Ethics approval

The present retrospective analysis was based on medical records of a prospective cohort of patients included in a registry of orthopedic surgical procedures. The study protocol for the development of this registry was approved by the Ethical Committee of Humanitas Research Hospital (approval number 618/17) and in strict accordance with the Helsinki Declaration.

Consent to participate and for publication

All individual participants signed a written informed consent before the surgical procedure and a written informed consent to be included in the registry of orthopedic surgical procedures.

Conflict of interest

Mattia Loppini received a research grant from the Italian Ministry of Health (GR-2018–12367275), as well as financial support for attending symposia and educational programs from Zimmer Biomet. He is also the Scientific Director of Livio Sciutto Foundation Biomedical Research in Orthopaedics – ONLUS. Guido Grappiolo received honoraria for speaking at symposia, financial support for attending symposia and educational programs from Zimmer Biomet, and royalties from Zimmer Biomet and Innomed. Francesco La Camera received financial support for attending symposia and educational programs from Zimmer Biomet. Alessandro Pisano, Marco Di Maio, and Maddalena Casana have no conflict of interest.

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Level of evidence: level IV, case series

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Loppini, M., Pisano, A., Di Maio, M. et al. Outcomes of patients with unexpected diagnosis of infection at total hip or total knee arthroplasty revisions . International Orthopaedics (SICOT) 45, 2791–2796 (2021). https://doi.org/10.1007/s00264-021-05137-8

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  • DOI: https://doi.org/10.1007/s00264-021-05137-8

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