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SHR Neuro Cancer Cardio Lipid Metab Microb

Russo, A; Budin, M; Luo, TD; Uribe, AC; Gehrke, T; Citak, M.
Open Biopsy is a Safe Procedure in Patients Who Have Suspected Periprosthetic Joint Infection of the Hip or Knee and Double Negative Joint Aspiration.
J Arthroplasty. 2025; Doi: 10.1016/j.arth.2025.05.102
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Co-authors Med Uni Graz

Budin Maximilian Johannes

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Abstract:

BACKGROUND: Diagnosis of periprosthetic joint infection (PJI) is complex, and it is based on the combination of clinical and laboratory criteria. In case of double culture-negative joint aspirations and suspected PJI, open biopsies can be performed to identify the underlying microorganism profile to increase the chance of treatment success. The aim of this study was to report the re-infection and re-revision rates of patients who underwent one- or two-stage septic exchange and had an open biopsy during their diagnostic work-up. METHODS: The institutional database of patients who underwent exchange between 2015 and 2018 was reviewed, looking for patients who had a prior open biopsy. Patients who had open biopsy after a single negative aspiration or had debridement, antibiotic irrigation, and retention of the implant as final treatment were excluded. A total of 62 patients were included. Mean age was 66 years (range, 42 to 81), and mean follow-up was 83.2 months (range, 65 to 103). Outcomes measured were re-infection, re-revision, complications, pathogens involved, and survivorship of implants. RESULTS: Of the 62 patients included (25 hips and 37 knees), 44 underwent one-stage exchange and 18 had two-stage exchange. Treatment was successful in 75.8 % of cases. Of the 25, five (20%) and 10 of the 37 (27%) patients who had hip or knee exchange underwent re-revision, respectively. The more frequent cause of failure was re-infection (nine cases, 14.5%). No significant difference was found in re-revision (P = 0.38) and re-infection (P = 0.63) rates between one- and two-stage exchange. No difference was found between hip and knee in terms of re-revision (P = 0.53) and re-infection (P = 0.21). The most common pathogens detected were Staphylococcus epidermidis (29.5%) and Propionibacterium acnes (20.5%). CONCLUSION: The implementation of open biopsies in the diagnostic work-up did not seem to increase the risk of re-infection after one- or two-stage exchange.

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