Risk Factors for Discordance Between Synovial Fluid Culture and Intraoperative Cultures in Revision Arthroplasties: Results From a European Multicentre Observational Study.

Ottink, Karsten D; Olearo, Flaminia; Vaznaisiene, Danguole; Rolvien, Tim; Kaoual, Salma; Morreel, Elizabeth; Bîrluţiu, Victoria; Gómez-Junyent, Joan et al. · JB JS Open Access · 2026

retrospective_cohort · Level III

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Abstract

Isolating the causative microorganism in patients with a periprosthetic joint infection (PJI) before revision surgery is critical to determine the right surgical and antibiotic strategy. A wide variety in concordance between p-SFC and intraoperative cultures is reported in the literature.The objective was to determine the incidence of discordance and analyze risk factors for discordance between a positive preoperative synovial culture and intraoperative cultures in revision arthroplasty for PJI. An international multicenter retrospective observational cohort study was conducted including patients with septic total revision arthroplasty, between January 2020 and January 2024. Discordance and risk factors were analyzed. Discordance was 36% (n = 647). Risk factors for discordance were center specific: OR 4.22 (95% confidence interval [CI] 2.97-5.99), the presence of a sinus tract: odds ratio (OR) 1.80 (95% CI 1.22-2.66), and the hip joint: OR 1.61 (95% CI 1.12-2.30). Discordance between positive preoperative synovial fluid culture and intraoperative cultures in revision arthroplasty is relatively high, center-specific, and less reliable in patients with hip arthroplasty and/or a sinus tract.