Sunday, February 17, 2013

"unexpected positive intraoperative cultures"

The fate of elbows with unexpected positive intraoperative cultures during revision elbow arthroplasty.
This study is an informal retrospective review of 213 elbows having revision surgery for indications other than clinically apparent infection. Sixteen patients had positive cultures. All of these patients had prosthetic loosening, periprosthetic fracture, or fracture of the component.  A small and inconstant number and type of specimens were sent for culture, the cultures were held for short periods of time (three days for aerobic and seven days for anaerobic), the media for culturing were not specified. It is not clear that all elbows were cultured and it is not clear whether or not preoperative antibiotics were withheld until cultures had been obtained. Only 12 of the patients had over two years of observation after the revision.  The authors conclude that 'the majority of patients [with unexpectedly positive cultures] were successfully treated without antibiotics with a low rate of failure."

The problems with this study lies in the difficulty in establishing rational definitions for 'contaminant', 'infection', 'infection-free', 'success' and 'failure' in a situation where none of these states can be determined with confidence. 

By the way, the x-ray shown above is one of our cases that, happily, has done fine without need for revision. You might like this youtube.


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