The role of intraoperative gram stain in the diagnosis of infection during revision total hip arthroplasty

Mark J. Spangehl, Eric Masterson, Bassam A. Masri, John X. O'Connell, Clive P. Duncan

Research output: Contribution to journalArticlepeer-review

58 Scopus citations


A total of 202 revision hip arthroplasties in 178 patients, over a 2- year period, were evaluated prospectively. Intraoperative Gram stains were obtained from periprosthetic tissues in all cases. Of these, a definitive diagnosis of infection, using defined criteria, was established in 35 cases. Of these 35 patients, 17 had received antibiotics before surgery. The intraoperative cultures were positive in 8 of the 17 patients who had received antibiotics and 17 of the 18 patients who had not received preoperative antibiotics. In 1 infected case, intraoperative cultures of periprosthetic tissues failed to reveal bacterial growth, despite the fact that the patient received no preoperative antibiotics. Overall, there were 5 true-positive Gram stain results, 172 true-negative results, 3 false-positive results, and 22 false-negative results. The sensitivity of the Gram stain was 19%, specificity was 98%, predictive value of a positive test was 63%, and predictive value of a negative test was 89%. These results suggest that the intraoperative Gram stain is not a sensitive tool for the diagnosis of infection and should not be used when attempting to diagnose infection intraoperatively.

Original languageEnglish (US)
Pages (from-to)952-956
Number of pages5
JournalJournal of Arthroplasty
Issue number8
StatePublished - Dec 1999


  • Failed arthroplasty
  • Gram stain
  • Infection

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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