Robert Whitfield MD removes all capsular tissue during explantation and sends it for pathology and culture. He finds organisms in capsular tissue that may warrant extended antibiotics in symptomatic patients, even without classic infection signs.
100%
Every capsule is removed in its entirety and sent for pathologic analysis.
You know, if we never looked, what would, how, how would we know if there's something there and, you know, the more you look, the more you find and then you can't, you know, look away anymore. You can't, you know, avoid it. And so you know, my standard protocol is every capsule gets removed in its entirety. They all go for pathologic analysis. The yield may be low, but it's not zero. 100% of them get bacterial and fungal cultures. The yield is high. Then you have to have conversations with patients. If they were symptomatic and they had colonies of organisms in their, in their capsular tissue, we're not talking about swabbing the implant. We're talking about embedded in their capsular tissue. If they've got colonies of organisms in there, if they've got symptoms preoperatively, do they deserve to be on an antibiotic for a more extended period of time? No, they're not classically infected.
