ArticleOrthopaedic surgery2026
Postoperative Antibiotic Duration and Treatment Failure After Aseptic Revision Arthroplasty With a Single Unexpected Positive Culture: A Retrospective Cohort Study.
Article in Orthopaedic surgery, 2026. 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
objectivesThe clinical significance of a single unexpected positive intraoperative culture (UPC) during aseptic revision arthroplasty remains unclear. This study primarily aimed to evaluate the association between postoperative antibiotic duration and treatment failure in patients with a single UPC after aseptic revision total hip or knee arthroplasty. A secondary aim was to compare failure-free survival between patients with a single UPC and those with multiple UPCs.
methodsWe retrospectively reviewed 51 presumed aseptic revision hip or knee arthroplasties with UPCs performed between January 1999 and December 2023. Cases meeting the 2018 ICM criteria for periprosthetic joint infection were excluded. Postoperative antibiotic duration was the exposure of interest. Treatment failure, defined as infection-related re-revision, was the primary outcome; failure-free survival was the secondary outcome. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were compared using chi-square or Fisher's exact tests. Factors associated with failure were examined using univariate logistic regression, and failure-free survival was assessed using Kaplan-Meier analysis with the log-rank test.
resultsAmong 39 patients with one UPC, treatment failure occurred in 18%. Antibiotic courses longer than 21 days were associated with failure (OR 28.1). In the small subgroup with available data (n = 13), synovial biomarkers did not show a statistically significant difference between success and failure groups. Patients with one UPC had better failure-free survival than those with ≥ 2 UPCs.
conclusionThe observed association between prolonged antibiotic therapy and treatment failure may reflect underlying infection severity rather than a causal effect of antibiotic duration. Individualized management is recommended for UPCs in aseptic revision arthroplasty.
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