Articles | Volume 11, issue 1
https://doi.org/10.5194/jbji-11-83-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
https://doi.org/10.5194/jbji-11-83-2026
© Author(s) 2026. This work is distributed under
the Creative Commons Attribution 4.0 License.
the Creative Commons Attribution 4.0 License.
High failure rate in Pseudomonas aeruginosa-associated periprosthetic hip and knee joint infections
Ece Akcicek
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria
Jennyfer A. Mitterer
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria
Center for Anatomy and Cell Biology, Medical University of Vienna, Vienna, Austria
Veronika Achatz
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria
Department of Orthopaedics and Trauma, Medical University of Graz, Graz, Austria
Tamino Szirmay
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria
Sujeesh Sebastian
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria
Michael Ogon Laboratory for Orthopaedic Research, Orthopaedic Hospital Speising, Vienna, Austria
2nd Department, Orthopaedic Hospital Speising, Vienna, Austria
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A simple, rapid, and low-cost test measuring synovial fluid specific gravity shows high accuracy and excellent specificity for diagnosing hip and knee periprosthetic joint infection. This method can quickly help rule in infections during revision surgeries, making it a practical point-of-care tool, especially in clinics or hospitals with limited resources. Its performance supports use alongside established lab markers for better patient outcomes.
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Proteus is a rare form of bacteria in periprosthetic joint infection (PJI) following knee and hip arthroplasties. In this study, we investigated culture-positive revision surgeries from 2008 until 2024. Proteus species were mainly found in hip arthroplasties. Furthermore, the infections of Proteus species were mainly prevalent in chronic revisions alongside multiple bacteria. Given their chronic and polymicrobial nature, the outcome of Proteus-associated PJIs is poor.
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We compared the re-revision rates in rTHA and rTKA (revison total hip and knee arthroplasty) with and without AB (antibiotic) treatment in patients with UPICs (unexpected positive intraoperative cultures). The re-revision rate between the AB group and the non-AB group was similar. Postoperative AB treatment did not result in a decreased re-revision rate in patients with UPICs in presumed aseptic rTHA and rTKA. Patients with pathogens classified as a likely contaminant can be safely ignored.
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Short summary
Pseudomonas aeruginosa is a common pathogen in Gram-negative periprosthetic joint infections (PJIs). It is resistant to many antibiotics and forms biofilm, making it difficult to treat. We analyzed 1286 patients who underwent 1640 surgeries; among them, 38 patients with 50 procedures had P. aeruginosa. Most infections were chronic, often in hip revisions, with a high failure rate and recurrence. Due to its clinical and microbiological features, P. aeruginosa-related PJIs remain challenging.
Pseudomonas aeruginosa is a common pathogen in Gram-negative periprosthetic joint infections...