Impact of positive cultures during the second stage of a 2-stage replacement
Background: Two-stage replacement is a frequently performed procedure in patients with chronic PJI. However, results in the literature after this procedure differ, ranging from 54% to 100% of infection eradication. Positive cultures at the moment of reimplantation, when performing the second stage, are perceived as a risk factor for reinfection. This project aims to determine the impact of positive cultures during the second stage on the outcome of patients undergoing a 2-stage septic replacement.
Material and Methods: we systematically searched MEDLINE, EMBASE, Web of Science and Cochrane databases from inception to May 31, 2022. We combined terms related to periprosthetic joint infection, those related to joint replacement and those related to culture results. Two independent reviewers performed the screening, data extraction and risk of bias assessment.
Results: we included 24 studies in this SR.The observed log odds ratios ranged from -0.8210 to 4.9127, with the majority of estimates being positive (92%). The estimated average log odds ratio based on the random-effects model was 1.4258 (95% CI: 1.0841 to 1.7675). Neither the rank correlation nor the regression test indicated any funnel plot asymmetry (p = 0.2675 and p = 0.0620, respectively).
Conclusions: This SR shows that there exists a higher risk of failure after a two-stage septic replacement when cultures are positives during the reimplantation procedure. Therefore, importance in detecting these patients before reimplantation procedure is crucial to ensure higher survival rates.