Summary

Two staged revision surgery yields good clinical outcomes at latest follow up with remission of infection in majority of patients. Sonication fluid culture of implant is more sensitive tool for identification of causative organisms as compared to conventional culture methods. Combined- gram negative organisms are leading cause of PJI and polymicrobial infections complicate both diagnosis and mana

Abstract

PJI is Devastating and costly complication following total joint arthroplasty (TJA) and etiology of implant failure, no single gold standard diagnostic test exists, making distinction between aseptic and septic failure extremely difficult. Two staged revision surgery remains gold standard. We aim to evaluate clinico-radiological outcomes of 2 staged revision surgery for PJI and various associated factors in cohort of 100 patients retrospectively.Clinical assessment will include calculation of Oxford knee score at latest follow up for all recruited patients .Radiological assessment will be done using radiographs of affected joint-looking for radiolucencies >2mm, Bone defects and fractures.For retrospective cohort -causative organism identification was possible only in 61.25 % cases with conventional culture methods, compared with 73.75 % for combined sonication fluid culture of implant and conventional tissue/pus culture. Staphylococcus sp.(Gram positive organism) remains leading cause of PJI(24.48%) although combined all gram negative organisms outweighs Staphylococcus sp as the leading cause of PJI(46.93 %).Small proportion of patients(4.08%) were found to be affected with Polymicrobial infection. Discordance of culture sensitivity results within various samples for same procedure and within different procedures for the same patient were noted in 8.16% patients. 16 % patients undergoing re-implantation surgery(stage 2) had positive culture sensitivity results and received postoperative antibiotics , still had inferior post-operative outcomes. Infections with Staphylococcus sp.(27.58%), Psedomonas sp.(17.24%) were associated with multiple redebridements in majority of patients and poor clinical scores at latest follow up.