SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2022
Prevalence, interpretation, and management of unexpected positive cultures in revision TKA: a systematic review.
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Who cites it
10 citing papers in PubMed, 2 syntheses or guidelines pooled it, 24 citations in OpenAlex.
- Unveiling the link: highly porous tantalum-augmented implants and periprosthetic joint infection in revision total knee arthroplasty-a systematic review and meta-analysis.BMC musculoskeletal disorders · 2025Pooled it
- Unexpected positive culture (UPC) in adults revision spine surgery: a systematic review and meta-analysis of incidence, risk factors, and management.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024Pooled it
- Ultrasound-activated piezoelectric Bi@Bi-MOF enables STING-mediated immunotherapy for implant-associated infections.Journal of nanobiotechnology · 2026Article
- Unexpected Positive Cultures During Aseptic Hip and Knee Revision Arthroplasty: Substantial Discrepancies in Laboratory Analyses.Antibiotics (Basel, Switzerland) · 2025Article
- 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.Journal of bone and joint infection · 2025Article
- Prevalence of unexpected intraoperative cultures (UPIC) in revision total knee arthroplasty (TKA) and risk of periprosthetic joint infection (PJI).Archives of orthopaedic and trauma surgery · 2024Article
- Prevalence, risk factors, microbiological results and clinical outcome in unexpected positive intraoperative cultures in unclear and presumed aseptic hip and knee revision arthroplasties - A ten-year retrospective analysis with a minimum follow up of 2 years.Journal of orthopaedic translation · 2024Article
- Article
- Multiplex PCR test as an intra-operative diagnostic tool for periprosthetic joint infection in presumed aseptic revision hip and knee arthroplasty: a 1-year follow-up study of 200 cases.Journal of bone and joint infection · 2024Article
- A machine learning-based model for "In-time" prediction of periprosthetic joint infection.Digital healthArticle
Corrections and comments
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeUnexpected positive intraoperative cultures (UPIC) found in revision total knee arthroplasty (TKA) are difficult to interpret. Management goes along with risks for both over- and undertreating a potential periprosthetic joint infection (PJI). The objective of this systematic review was to determine the prevalence of UPIC in revision TKA surgery, evaluate the diagnostic workup process and the postoperative treatment, and assess outcome regarding re-revision rates.
methodsEvidence was gathered from Medline (PubMed) and Embase published from January 2000 until April 2021. Nine studies with data of UPIC in revision TKA and outcome after at least 2 years of follow-up were identified.
resultsThe calculated prevalence of UPIC in aseptic knee revision surgery was 8.32%. However, the diagnostical approach differs as well as the used criteria to confirm PJI in presumed aseptic revision surgery. The work-up generally consists of a serum C-reactive protein and Erythrocyte Sedimentation Rate, joint fluid aspiration for culture and white blood cell count and formula, and radiographic imaging. Collection of intraoperative cultures is widely used, but inconsistent in sample amount and incubation time. Once a single UPIC is found, surgeons tend to treat it in different ways. Regarding re-revision rates, the weighted arithmetic mean in the included studies was 18.45% in the unsuspected PJI group compared to 2.94% in the aseptic group. There also seems to be a trend towards higher re-revision rates when a higher number of intraoperative cultures are positive.
conclusionThe interpretation of UPIC in revision TKA is of utmost importance since the decision whether to treat a UPIC as an unsuspected PJI has a major impact on implant survival and re-revision rate. Different criteria are used to differentiate between unsuspected PJI and contamination in true aseptic failure, and the heterogeneity amongst the included papers impedes to state a clear recommendation, integrating not only quantitative findings, but also qualitative data such as virulence of the identified microorganism. LEVEL OF EVIDENCE: Systematic review, III.
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