Unexpected positive intraoperative cultures (UPIC) in revision Hip and knee arthroplasty- A review of the literature

Prabhudev Prasad Purudappa; Om Prakash Sharma; Sruthi Priyavadana; Senthil Sambandam; Jorge A Villafuerte

doi:10.1016/j.jor.2019.06.028

Unexpected positive intraoperative cultures (UPIC) in revision Hip and knee arthroplasty- A review of the literature

J Orthop. 2019 Jul 2:17:1-6. doi: 10.1016/j.jor.2019.06.028. eCollection 2020 Jan-Feb.

Authors

Prabhudev Prasad Purudappa¹, Om Prakash Sharma², Sruthi Priyavadana³, Senthil Sambandam⁴, Jorge A Villafuerte¹

Affiliations

¹ Boston VA Medical Centre, 150 S Huntington Avenue, Boston, MA, 02130, USA.
² Essentia Health St. Mary's-Detroit Lakes Clinic, 1027 Washington Ave, Detroit Lakes, MN, 56501, USA.
³ 43, 3rd Main Road, Lakshmi Nagar, Porur, Chennai, 600116, India.
⁴ Louis A Johnson VAMC, Clarksburg, WV, 26501, USA.

Abstract

Unexpected positive intraoperative culture (UPIC) in revision hip and knee arthroplasty has a prevalence of 10.5%, there is no consensus in the literature on how to interpret them and how to treat them. Our literature review showed that most authors would consider two or more positive cultures as significant and usually treat them with culture specific antibiotics for 4-6 weeks. A single positive intraoperative culture can or cannot be significant depending on the virulence of the organism, hence taking multiple tissue samples in and around the joint is recommended. All failed arthroplasty cases must be evaluated preoperatively according to musculoskeletal infection society criteria (MSIS) to rule out the possibility of infection as an etiology for failure of the arthroplasty. Most authors reported that large majority of these UPIC were from a low virulence organism. Our review showed that the implant survival is more than 85% with 4-6 weeks of antibiotic treatment.

Keywords: Aseptic failure; Prosthetic joint infection; Revision arthroplasty; Unexpected positive culture.

Publication types

Review