Cutibacterium infections after total hip arthroplasty: does surgical approach play a role?

Abstract

Purpose: Cutibacterium species, formerly known as Propionibacterium, are gram-positive, anaerobic bacilli increasingly recognized as a cause of periprosthetic joint infection (PJI) following total hip arthroplasty (THA). This study aimed to compare the incidence of Cutibacterium-associated PJI among different surgical approaches for THA.

Methods: A retrospective review was conducted on patients treated for Cutibacterium-associated PJI following THA between 2011 and 2021. Patients were categorized based on the surgical approach: direct anterior (DAA), lateral, or posterior. A total of 211 patients met inclusion criteria, comprising 153 men (72.5%) and 58 women (27.5%).

Results: Among the 211 cases of Cutibacterium-associated PJI, 102 (48.3%) underwent THA via DAA, 63 (29.9%) via a lateral approach, and 46 (21.8%) via a posterior approach. There were no significant differences between groups in age, sex, laterality, BMI or fistula formation. The incidence of Cutibacterium PJI was significantly higher with DAA compared to the lateral (P < 0.001) and posterior approaches (P < 0.001), while no significant difference was observed between lateral and posterior approaches (P = 0.059). The rate of Cutibacterium-associated PJI has increased since 2016.

Conclusion: Nearly half of all Cutibacterium PJIs were associated with the DAA. Surgeons should be aware of this increased risk and implement appropriate preventive measures when performing THA via DAA.

Keywords: Cutibacterium acnes; Cutibacterium avidum; Direct anterior approach; Hip arthroplasty; Periprosthetic joint infection; Propionibacterium acnes.