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The Fate of Elbows with Unexpected Positive Intraoperative Cultures During Revision Elbow Arthroplasty
Andy T. Wee, MBBS1; Bernard F. Morrey, MD2; Joaquin Sanchez-Sotelo, MD2
1 Department of Orthopaedic Surgery, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768826. E-mail address for A.T. Wee: wee.andy.th@alexandrahealth.com.sg
2 Department of Orthopedic Surgery, Mayo Clinic Rochester, 200 First Street SW, Rochester, MN 55905. E-mail address for J. Sanchez-Sotelo: sanchezsotelo.joaquin@mayo.edu
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  • Disclosure statement for author(s): PDF

Investigation performed at the Mayo Clinic, Rochester, Minnesota

This article was chosen to appear electronically on December 12, 2012, in advance of publication in a regularly scheduled issue.

Disclosure: None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. One or more of the authors, or his or her institution, has had a financial relationship, in the thirty-six months prior to submission of this work, with an entity in the biomedical arena that could be perceived to influence or have the potential to influence what is written in this work. No author has had any other relationships, or has engaged in any other activities, that could be perceived to influence or have the potential to influence what is written in this work. The complete Disclosures of Potential Conflicts of Interest submitted by authors are always provided with the online version of the article.

Copyright © 2013 by The Journal of Bone and Joint Surgery, Inc.
J Bone Joint Surg Am, 2013 Jan 16;95(2):109-116. doi: 10.2106/JBJS.K.00121
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An intraoperative culture sample obtained during revision elbow arthroplasty that is unexpectedly positive poses a dilemma for the surgeon. The purpose of our study was to determine the prevalence of positive cultures during revision elbow arthroplasty when infection is not suspected preoperatively, and the long-term implications of these positive cultures.


Two hundred and thirteen consecutive revision elbow arthroplasties were performed at our institution between 2000 and 2007. Of these, sixteen patients had unexpected positive intraoperative cultures.


The majority of cultures grew either Staphylococcus epidermidis or Propionibacterium acnes. Twelve patients had more than two years of follow-up. One of the twelve patients was treated as for an infection because of unexplained early implant loosening and the isolation of Staphylococcus epidermidis. Ten of the twelve elbows were treated as “contaminants” and did not receive long-term antibiotic treatment. Nine of these ten remained infection-free at the time of the final follow-up, while the remaining one developed an infection with a different organism.


In our series, there was a 7.5% chance of encountering an unexpected positive result on intraoperative culture at the time of revision elbow arthroplasty. The majority of patients were successfully treated without antibiotics with a low rate of failure. A minority were considered as infections, typically presenting with unexplained early loosening and isolation of an organism on solid culture medium.

Level of Evidence: 

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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