The incidence of detectable bacterial contaminated primary joint arthroplasties and periprosthetic joint infection: a systematic review and meta-analysis

Purpose: The association between positive intraoperative cultures during primary joint arthroplasty and periprosthetic joint infections (PJIs) remains controversial. This systematic review and meta-analysis examines the association between intraoperative contamination and complications such as PJIs and revision rates. Methods: We searched PubMed, Web of Science, Cochrane, Emcare (OVID), Embase (OVID), MEDLINE, Academic Search Premier and the references of included studies evaluating the outcome of contaminated and non-contaminated primary joint arthroplasties. This systematic review and meta-analysis was performed according to the PRISMA statement, and the research protocol was uploaded a priori at Open Science Framework. Two researchers independently reviewed all the titles, abstracts and full texts, and extracted the available data. Study eligibility criteria were primary joint arthroplasty with cultures taken during initial procedure and documentation of PJIs and revision rates. Results: The search yielded 26 studies after inclusion and exclusion criteria, involving 4,556 primary joint arthroplasties. The overall incidence of bacterial contamination was 24.7% (95% CI: 19-30%). The incidence of PJIs was 2.0% (95% CI: 1.1-2.8%) in the contaminated group versus 1.0% (95% CI: 0.6-1.4%) in the non-contaminated group, with a pooled adjusted risk ratio (RR) of 2.0 (95% CI: 1.3-3.1). The pooled analysis revealed an increased risk of contaminated joint arthroplasties for revision for any reason, with a pooled RR of 1.86 (95% CI: 1.14-3.03). Conclusion: This systematic review and meta-analysis suggests intraoperative bacterial contamination may increase the risk of PJIs and the risk of revision in primary hip, knee and shoulder arthroplasty. However, over more than 9 out of 10 patients with an intraoperative contaminated joint arthroplasty did not develop a PJI.