Intraoperative Cultures for the Suspected Total Knee Arthroplasty Infection

Technique/action

With implementation

Without implementation or against rival procedure

Comments

Sensitivity (%)

Specificity (%)

Sensitivity (%)

Specificity (%)

Withholding antibiotic prior to sampling >2 weeks [10]

76.9

N/a

41.2

N/a

Joint aspiration [7, 8]

80–83

94–100

79–83 (open biopsy)

90–100 (open biopsy)

Aspiration and open biopsy [7, 8]

100

80–83 (aspiration alone)

94–100 (aspiration alone)

Swab culture [16, 40]

61–70

89–99

69–93 (PPT culture), 86 (synovial fluid)

81–98 (PPT culture), 100 (synovial fluid)

No longer recommended

BCB culturing of synovial fluid [16, 30]

86–92

100

46–69

81–100

80% detection rate of organisms and 1% contamination rate vs 66% and 14%, respectively, in conventional media culture

BCB culturing of PPT [18, 62]

87–92.1

98–99.7

57 (fastidious anaerobic broth)

39 (agar plates)

100 (fastidious anaerobic broth)

100 (agar plates)

Broth usage prior to agar plate inoculation [18, 62]

62.6–83

97–98.1

39–48.9

99.7–100

Gram stain [31–33, 69]

0–27

92–100

No longer recommended

Feldman histological criteria [58, 59]

100

71.4 (Athanasou)

86.6 (Morawietz)

64.2 (Athanasou)

100 (Morawietz)

In the Morawietz analysis, 19% of fresh-frozen specimens were not included due to “unclear results” thus biasing the results

Membrane sample for histology [45]

42 (synovial capsule/pseudo-capsule)

98 (synovial capsule/pseudo-capsule)

Synovial white cell count (SWCC)—1100–1700 μl [10, 34–36]

90–94

88–91

84 (SWCC >4200)

93 (SWCC >4200)

References

Parvizi J, Della Valle CJ. AAOS clinical practice guideline: diagnosis and treatment of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010;18:771–2.CrossrefPubMed

Atkins BL, Athanasou N, Deeks JJ, Crook DW, Simpson H, Peto TE, McLardy-Smith P, Berendt AR. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. J Clin Microbiol. 1998;36:2932–9.PubMedPubMedCentral

Parvizi J, Zmistowski B, Berbari EF, et al. New definition for periprosthetic joint infection: from the workgroup of the Musculoskeletal Infection Society. Clin Orthop Relat Res. 2011;469:2992–4.CrossrefPubMedPubMedCentral

Minassian AM, Newnham R, Kalimeris E, Bejon P, Atkins BL, Bowler IC. Use of an automated blood culture system (BD BACTECTM) for diagnosis of prosthetic joint infections: easy and fast. BMC Infect Dis. 2014;14:233.CrossrefPubMedPubMedCentral

Marculescu CE, Berbari EF, Cockerill FR, Osmon DR. Unusual aerobic and anaerobic bacteria associated with prosthetic joint infections. Clin Orthop Relat Res. 2006;451:55–63.CrossrefPubMed

Fink B, Makowiak C, Fuerst M, Berger I, Schäfer P, Frommelt L. The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Joint Surg Br. 2008;90:874–8.CrossrefPubMed

Meermans G, Haddad FS. Is there a role for tissue biopsy in the diagnosis of periprosthetic infection? Clin Orthop Relat Res. 2010;468:1410–7.CrossrefPubMedPubMedCentral

Williams JL, Norman P, Stockley I. The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery. J Arthroplast. 2004;19:582–6.Crossref

Burnett RS, Kelly MA, Hanssen AD, Barrack RL. Technique and timing of two-stage exchange for infection in TKA. Clin Orthop Relat Res. 2007;464:164–78.PubMed

10.

Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, Mandrekar JN, Cockerill FR, Steckelberg JM, Greenleaf JF, Patel R. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;35:654–63.Crossref

11.

Malekzadeh D, Osmon DR, Lahr BD, Hanssen AD, Berbari EF. Prior use of antimicrobial therapy is a risk factor for culture-negative prosthetic joint infection. Clin Orthop Relat Res. 2010;468:2039–45.CrossrefPubMedPubMedCentral

12.

Baron EJ, Miller JM, Weinstein MP, et al. A Guide to utilization of the microbiology laboratory for diagnosis of infectious diseases: 2013 recommendations by the Infectious Diseases Society of America (IDSA) and the American Society for Microbiology (ASM)(a). Clin Infect Dis. 2013;57:e22–e121.CrossrefPubMedPubMedCentral

13.

www.bd.com/ds/technicalCentre/inserts/L004300(201001).pdf. Accessed 5 Dec 17.

14.

Barrack RL, Jennings RW, Wolfe MW, Bertot AJ. The Coventry Award: the value of preoperative aspiration before total knee revision. Clin Orthop Relat Res. 1997;345:8–16.Crossref

15.

Dory MA, Wautelet MJ. Arthroscopy in septic arthritis. Lidocaine and iodine containing contrast media are bacteriostatic. Arthritis Rheum. 1985;28:198–203.CrossrefPubMed

16.

Font-Vizcarra L, García S, Martínez-Pastor JC, Sierra JM, Soriano A. Blood culture flasks for culturing synovial fluid in prosthetic joint infections. Clin Orthop Relat Res. 2010;468:2238–43.CrossrefPubMedPubMedCentral

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