ArticleArchives of orthopaedic and trauma surgery2025
Does methylene blue affect culture yield in total knee arthroplasty periprosthetic joint infection?
Article in Archives of orthopaedic and trauma surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMethylene blue (MB), a phenothiazine dye with antimicrobial activity, is used to stain soft tissues and guide thoroughness of debridement during revision total knee arthroplasty (rTKA) for periprosthetic joint infection (PJI). The purpose of this study was to determine if instillation of MB prior to arthrotomy impacts culture yield in TKA PJI.
methodsWe retrospectively reviewed 266 patients diagnosed with TKA PJIs according to the 2018 International Consensus Meeting (ICM) criteria from January 2018 - March 2023 at a single academic hospital. Demographics, perioperative outcomes, and preoperative and intraoperative culture positivity were compared between patients who received intraoperative MB (MB group; n = 26) and those who did not (nMB group; n = 241). A record of detected organisms was included in the analysis.
resultsThere was no difference in preoperative aspiration culture positivity between groups. However, the MB group had a higher percentage of preoperative to intraoperative culture concordance (89.5 vs. 69.9%; P = 0.04). Although the overall rate of intraoperative culture positivity did not differ significantly between groups, the MB group had more intraoperative cultures obtained per patient (4.9 vs. 4.5; P = 0.02) and higher numbers of positive intraoperative cultures per patient. Concordance rates for patients in both groups with positive preoperative and negative intraoperative cultures were similar (10.5 vs. 16.5%, P = 0.50). Among patients with negative preoperative cultures, intraoperative culture positivity was more discordant in the MB group (0 vs. 18.8%; P = 0.03). There was no difference in the number of patients that received antibiotics following aspiration (68.4 vs. 49.6%; P = 0.12).
conclusionWhile MB use did not affect overall culture positivity, it could interfere with intraoperative pathogen detection in patients with negative preoperative cultures. In these cases, MB should be avoided to decrease inaccuracies in intraoperative culture yield. If preoperative cultures are positive, MB may improve surgical debridement and likelihood of infection eradication.
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