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J Arthroplasty. 2013 Sep;28(8 Suppl):59-65. doi: 10.1016/j.arth.2013.03.037. Epub 2013 Jul 23.

Multiple cultures and extended incubation for hip and knee arthroplasty revision: impact on clinical care.

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Department of Orthopaedics and Rehabilitation, Oregon Health and Science University, Portland, Oregon.


The impact on patient care of introducing a protocol of obtaining 5 or more intra-operative separate tissue biopsies that were cultured for 10 days was assessed for hip and knee arthroplasty revision. The charts of seventy-three patients undergoing 77 cases of revision arthroplasty were reviewed one year post-operatively. When compared to the prior standard of obtaining only one intra-operative culture, the protocol changed the microbiological diagnosis in 26/77 cases (34%, 95% Confidence Interval (CI): 23-45%) and antibiotic treatment in 23/77 cases (30%, 95% CI: 20-41%). In addition, the protocol had a predictive value of joint sterility in culture negative cases of 95% (95% CI: 85-99%). This data demonstrated the new protocol significantly changed patient care, and suggests that 1 or 2 cultures are insufficient. Adopting a similar protocol should be considered by surgeons and institutions as a new minimum standard for management of prosthetic joint infections.


hip arthroplasty; infection; knee arthroplasty; multiple cultures; revision arthroplasty

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