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. 2025 Mar 7;10(2):51-59.
doi: 10.5194/jbji-10-51-2025. eCollection 2025.

Postoperative antibiotic treatment does not lower re-revision rate in presumed aseptic hip and knee revision arthroplasties with unexpected positive intraoperative cultures - a matched cohort study

Sebastian Simon  1   2 , Marjan Wouthuyzen-Bakker  3 , Susana Gardete Hartmann  1 , Jennyfer A Mitterer  1   2 , Sujeesh Sebastian  1 , Stephanie Huber  1   4 , Bernhard J H Frank  1   5 , Jochen G Hofstaetter  1   4
Affiliations

Postoperative antibiotic treatment does not lower re-revision rate in presumed aseptic hip and knee revision arthroplasties with unexpected positive intraoperative cultures - a matched cohort study

Sebastian Simon et al. J Bone Jt Infect. .

Abstract

Aims: It remains unclear if postoperative antibiotic (AB) treatment is advantageous in presumed aseptic revision arthroplasties of the hip (rTHA) and knee (rTKA) with unexpected positive intraoperative cultures (UPIC). The aim of this study is to evaluate if there is a difference in the re-revision rate in patients with UPIC when treated with postoperative AB or when postoperative AB is withheld. Methods: In this retrospective matched cohort study we compared the re-revision rates in rTHA and rTKA with (AB group: 45 rTHA, 25 rTKA) and without (non-AB group: 45 rTHA, 25 rTKA) AB treatment in patients with UPIC. Baseline covariates for matching were the microorganism (likely or not likely to be a contaminant), patient demographics, joint, revision type, surgical site infection score, American Society of Anesthesiologists classification, serum C-reactive protein (CRP). Results: After a median follow-up of 4.1 (inter-quartile range, IQR: 2.9-5.5) years after rTHA and rTKA, the re-revision rate between the AB group and the non-AB group was 14.3 % versus 15.7 % (P=0.81). In the AB group, 4.3 % (3/70) of patients underwent revision due to septic complications compared to 5.7 % (4/70) in the non-AB group (P=0.69). None of the patients were diagnosed with a confirmed periprosthetic joint infection (PJI) according to the PJI diagnostic criteria of European Bone and Joint Infection Society (EBJIS). In 22/70 (31.4 %) of the patients in the AB group and in 15/70 (21.4 %) of the patients in the non-AB group, a diagnosis of "infection likely" was made according to the EBJIS criteria (P=0.18). All UPICs with low virulent microorganisms were considered to be contamination (coagulase-negative Staphylococci; Corynebacterium; anaerobic Gram-positive bacilli and cocci, e.g., Finegoldia magna, Cutibacterium acnes). Conclusion: Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPIC in presumed aseptic rTHA and rTKA. Patients diagnosed with pathogens classified as a likely contaminant can be safely ignored.

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Conflict of interest statement

At least one of the (co-)authors is a member of the editorial board of Journal of Bone and Joint Infection. The peer-review process was guided by an independent editor, and the authors also have no other competing interests to declare.

Figures

Figure 1
Figure 1
Figure 1Flow chart for propensity score matching in rTHA (revision total hip arthroplasty) and rTKA (revision total knee arthroplasty) with UPICs (unexpected positive intraoperative cultures). EBJIS (European Bone and Joint Infection Society), BMI (body mass index), SSI (surgical site infections), AB (antibiotic), PMN (polymorphonuclear leukocytes), ASA (American Society of Anesthesiologists Classification), and median with IQR (inter-quartile range).
Figure 2
Figure 2
Figure 2Revision-free implant survival after 1 a, 2 a, 5 a and 8 a (95 % confidence interval) (a: years, AB: antibiotic).
See this image and copyright information in PMC

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