Risk Factors for Discordance Between Synovial Fluid Culture and Intraoperative Cultures in Revision Arthroplasties
Background: Isolating the causative microorganism in patients with a periprosthetic joint infection (PJI) before revision surgery is critical to determine the right surgical and antibiotic strategy. A wide variety in concordance between p-SFC and intraoperative cultures is reported in the literature.The objective was to determine the incidence of discordance and analyze risk factors for discordance between a positive preoperative synovial culture and intraoperative cultures in revision arthroplasty for PJI. Method: An international multicenter retrospective observational cohort study was conducted including patients with septic total revision arthroplasty, between January 2020 and January 2024. Discordance and risk factors were analyzed. Results: Discordance was 36% (n = 647). Risk factors for discordance were center specific: OR 4.22 (95% confidence interval [CI] 2.97-5.99), the presence of a sinus tract: odds ratio (OR) 1.80 (95% CI 1.22-2.66), and the hip joint: OR 1.61 (95% CI 1.12-2.30). Conclusion: Discordance between positive preoperative synovial fluid culture and intraoperative cultures in revision arthroplasty is relatively high, center-specific, and less reliable in patients with hip arthroplasty and/or a sinus tract.
Authors
- M. Wouthuyzen-Bakker
- Flaminia Olearo (ORCID: https://orcid.org/0000-0002-5118-9523)
- Micael Widerström (ORCID: https://orcid.org/0000-0002-1483-4255)
- Karsten D. Ottink (ORCID: https://orcid.org/0000-0003-3168-6562)
- Victoria Bîrluțiu (ORCID: https://orcid.org/0000-0001-7391-3394)
- Tim Rolvien (ORCID: https://orcid.org/0000-0003-1058-1307)
- Ewout S. Veltman (ORCID: https://orcid.org/0000-0001-6334-0967)
- Sabine Petersdorf
- Sophie Reissier (ORCID: https://orcid.org/0009-0009-2806-4739)
- Elizabeth Morreel
- Joan Gómez-Junyent
- Martin Lindberg-Larsen
- Maria Dolores Del Toro Lopez
- Holger Rohde
- Nicolò Rossi
- Danguole Vaznaisiene
- Salma Kaoual
- Marta Fernandez Sampedro
Institutions
- Lithuanian University of Health Sciences (LT)
- University Medical Center Groningen (NL)
- Witten/Herdecke University (DE)
- Universität Hamburg (DE)
- Universitat Pompeu Fabra (ES)
- Maastricht University Medical Centre (NL)
- Odense University Hospital (DK)
- Eppendorf (Germany) (DE)
- Erasmus MC (NL)
- Maastricht University (NL)
- Higher Institute of Management (RU)
- Hospital Universitario Virgen Macarena (ES)
- Marqués de Valdecilla University Hospital (ES)
- Spaarne Ziekenhuis (NL)
- University Medical Center Hamburg-Eppendorf (DE)
- Hospital Del Mar (ES)
- County Hospital (GB)
- Guglielmo da Saliceto Hospital (IT)
- Centre Hospitalier Universitaire de Rennes (FR)
- Umeå University (SE)
- Rotterdam University of Applied Sciences (NL)
Publication Details
- Journal
- JBJS Open Access
- Published
- 2026-04-01
- DOI
- https://doi.org/10.2106/jbjs.oa.26.00067
- Primary Topic
- Orthopaedic implants and arthroplasty
- Type
- article
- Field-Weighted Citation Impact
- 0.00