HOW DO YOU MANAGE THE PATIENT WITH AN UNEXPECTEDLY POSITIVE CULTURE AT THE TIME OF A REVISION TOTAL KNEE ARTHROPLASTY?

Many surgeons performing a revision total knee arthroplasty for presumed aseptic loosening obtain intraoperative specimens for culture. If these specimens unexpectedly grow one or more culture can carry with it serious implications, interpretation of such a result must take a number of factors into account. The literature currently recognizes four distinct clinical scenarios that can produce a positive culture: (1) the unexpected positive intraoperative culture; (2) early postoperative infection; (3) late chronic infection, and (4) presumed acute hematogenous infection. ¹ While there is a strong preference for operative management of the early, chronic, and acute hematogenous infections, the patient with an unexpected positive culture at the time of revision can oftentimes be managed with antibiotic therapy or even observation alone. In this clinical scenario, the patient’s preoperative evaluation, appearance of the wound at the time of surgery, and tissue culture results are all factored into the treatment decision. Here, we describe our approach to the unexpected positive culture obtained during revision total knee arthroplasty.