Saturday, February 27, 2016

Periprosthetic infections: Stealth (Propionibacterium) vs Obvious (MSSA) in the total knees

Clinical Analysis of Propionibacterium acnes Infection after Total Knee Arthroplasty

These authors compared patients undergoing revision TKA for infection from P. acnes and methicillin sensitive Staphylococcal aureus (MSSA) Patients were classified as having a periprosthetic joint infection (PJI) based on the Musculoskeletal Infection Society criteria.

Sixteen patients with a P. acnes and 30 with a MSSA TKA PJI were identified. 

Median ESR was significantly higher in the MSSA group compared to the P. acnes group (56.0 mm/hr vs. 23.0 mm/hr, as were C-reactive protein levels (5.9 mg/dl vs 2.0 mg/dl).

Mean time to culture was 8.3±2.0 days in the P. acnes group and 1.8±0.8 days in the MSSA group.

Comment: As this case series and others point out, Propionibacterium infections are not unique to the shoulder. While the Musculoskeletal Infection Society criteria were used to select cases for this report, we know that many failed arthroplasties that are culture positive for Propionibacterium will not meet these criteria.

It may be important to culture tissue and explants from apparently 'aseptic' failure of total hip and knee arthroplasty for Propionibacterium using aerobic an anaerobic media observed for 3 weeks. It is for sure that the clinical presentation of a PJI with Propionibacterium is most likely to be of the 'stealth' variety, in contrast to the 'obvious' type of infections that meet the Musculoskeletal Infection Society criteria.