Organisms Identified on Sequencing that Could Predict Reinfection in Revision Total Joint Replacements

For Immediate Release
November 9, 2019

Dallas, November 9, 2019 – The multicenter study, “Reinfection or Persistence of Periprosthetic Joint Infection? Next Generation Sequencing Reveals New Findings,” presented by Karan Goswami, MD, at the 2019 AAHKS Annual Meeting hypothesized that an organism present at the time of initial revision surgery could be responsible for subsequent failure of total joint replacements due to infection. 

According to Dr. Goswami and senior author, Javad Parvizi, MD, members of the Orthopedic Genomics Workgroup: 

“Surgical management of PJI remains challenging with patients failing treatment despite our best efforts. An important question is whether these later failures reflect reinfection or the persistence of infection. Proponents of reinfection believe hosts are vulnerable to developing infection and new organisms emerge. The alternative hypothesis is that later failure is a result of an organism that was present but had not been given the chance to become a pathogen or was under antibiotic pressure and then turned into a pathogen.  

This prospective study involving 15 institutions collected samples from 635 revision total hip (n=310) and knee (n=325) arthroplasties. Synovial fluid, tissue and swabs were obtained intraoperatively for NGS analysis. Patients were classified per 2018 Consensus definition of PJI. Treatment failure was defined as reoperation for infection that yielded positive cultures during minimum 1-year follow-up. Concordance of the infecting pathogen cultured at failure with NGS analysis at initial revision was determined.  

Among the total cohort, 203 revisions were considered infected and 432 were aseptic (based on ICM criteria). Of the infected cases, 157 were NGS-positive and 46 NGS-negative. Twenty-nine ICM-positive patients (29/157; 18.5%) failed by reoperation with an organism confirmed on culture. In 23 of these (23/29; 79.3%), the organism at failure was present on NGS at initial revision. The remaining 6 cases detected discordant organisms between initial NGS and culture at failure. Of the 432 ICM-negative patients, NGS identified microbes in 48.1% (208/432) of “aseptic” revisions, and 17 of these failed. Thirteen of the 17 failures (76.5%) were due to an organism previously detected by NGS at initial revision.” 

The study suggests that most failures (~79.3%) by infection recurrence could be attributed to an organism previously detected by NGS at index revision surgery. 

Abstract: http://meeting.aahks.org/wp-content/uploads/2019/10/19_paper-31-goswami.pdf 

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About the American Association of Hip and Knee Surgeons (AAHKS) 

Established in 1991, the mission of AAHKS is to advance hip and knee patient care through education, advocacy and research. AAHKS has a membership of over 4,000 surgeons and other hip and knee health care professionals. 

Contact
Denise Smith Rodd
drodd@operationwalkglobal.org