Relationship between Intraoperative Cultures during Hip Arthroplasty,Obesity,and the Risk of Early Prosthetic Joint Infection: A Prospective Study of 428 Patients

Abstract

Purpose

To evaluate the relationship between intraoperative cultures during hip arthroplasty, the different patient characteristics, and the risk of developing a prosthetic joint infection (PJI).

Methods

A prospective observational study was performed. Patients who underwent elective THA from March 2007 to March of 2011 were included. Three samples were taken just after arthrotomy: synovial fluid inoculated into blood culture flasks (SF), a tissue sample (TS), and a swab of periprosthetic tissue (S). Patients received standard antibiotic prophylaxis. The PJI rate within the first 3 months after arthroplasty was recorded.

Results

402 prostheses were included in the study. Contamination rate of synovial fluid was 10.2%. The most frequent isolated microorganism was coagulase-negative staphylococci (CoNS) (32 out of 41). Body mass index (BMI) was the only host characteristic associated with positive intraoperative culture (p=0.009). The PJI rate was 3.7%. Variables associated with PJI in the univariate and multivariate analysis were: age ≥67 years (p=0.012 OR: 5.35 (1.45–19.81); CI95%) and a BMI ≥35 (p=0.002, OR: 7.7 (2.12–27.85) CI95%). PJI rate among patients with BMI<35 with negative and positive intraoperative cultures was 3% and 2.7%, respectively, however, the rate among patients with BMI ≥ 35 was 15% and 25%, respectively.

Conclusion

A BMI ≥35 was associated with a higher risk of positive intraoperative culture during hip arthroplasty. In addition, a BMI ≥35 was independently associated with a high risk of PJI and the highest rate was documented among obese patients with positive intraoperative cultures.