A new retrospective study involving 202 patients has found that if a preoperative allograft culture is positive, there is not necessarily a higher probability that the person will develop a knee infection.
New Study Tackles Allograft Infection Risk
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Secondary#allograft#kneeinfection
The new study, “No association between positive intraoperative allograft cultures and infection rates after reconstructive knee ligament surgery,” was published in the December 2018 edition of The Knee.
Carlos Gomez, M.D. orthopedic surgeon at the Clinica Alemana de Santiago in Chile and co-author told OTW, “Our team has always been taking preoperative culture samples of allograft ligaments that are brought from other laboratories, as a way of controlling the quality of the process of sterilization. Then, when one of our patients developed a serious deep knee infection a few years ago we decided to review our database and the literature on this topic.”
For his review, Dr. Gomez examined records for 300 allografts implanted in 202 patients who had knee reconstructive ligament surgeries, including revision.
After reviewing the results, Dr. Gomez and his co-authors said: “The most frequently isolated organism was Bacillusspecies (six cultures); none of these patients presented with clinical signs of infection. Nine patients developed surgical site infections and were treated with oral antibiotics, and one patient developed septic arthritis that required surgical debridement of the implanted graft; all of these patients had a negative soft tissue allograft culture. No significant association was found between a positive culture and surgical site infection.”
“The main result,” Dr. Gomez told OTW, “is that if an allograft culture sample taken before surgery turns out to be positive, this doesn’t mean there is a higher probability of developing a knee infection. This and other studies have shown consistently that there is no need to take a preoperative culture sample from a ligamentous allograft, as its result will not change our actions on the care of the patient.”
“With today’s high quality sterilization techniques, it is very safe to implant a ligamentous allograft in a patient.”
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This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?
Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.
We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.
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