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Diagnostic utility of open biopsy in patients with two culture-negative aspirations in the diagnostic work-up of periprosthetic joint infection

  • Orthopaedic Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Different approaches have been proposed for bacterial identification in patients with a suspected periprosthetic joint infection (PJI).

If a one-stage procedure is considered, a higher rate of preoperative bacterial identification can be achieved if biopsy is included in the diagnostic work-up. The performance of open biopsy (OB) in the context of PJI has not been clearly determined yet.

The purpose of this study was to determine the value of an OB added to two consecutive culture-negative joint aspirations during PJI workup.

Materials and methods

We retrospectively analyzed the OB data from a single institution. Patients under PJI work-up of the hip or knee with two culture-negative periprosthetic aspirations who underwent OB were included.

Sensitivity and specificity were calculated using the musculoskeletal infection society (MSIS) criteria as gold standard.

Patients undergoing urgent irrigation and debridement and patients with history of surgery to the affected joint in the prior 6 weeks were excluded.

Results

126 patients were included in this study. 62 (49.2%) patients had prior revisions, 48 of them due to PJI. The sensitivity and specificity of OB was 69.4% and 89.1%, respectively. The OB procedure led to the identification of the causative germ in 50 out of 126 (40%) cases so they could undergo one-stage (septic) exchange.

Conclusion

The OB is a valuable resource if preoperative synovial fluid cultures are negative, a high suspicion of infection persists and a one-stage procedure is preferred. It intends bacteria identification and allows surgeons to evaluate prosthetic complications for further surgical procedures.

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References

  1. Workgroup Convened by the Musculoskeletal Infection Society (2011) New definition for periprosthetic joint infection. J Arthroplasty 26:1136–1138. https://doi.org/10.1016/j.arth.2011.09.026

    Article  Google Scholar 

  2. Shohat N, Bauer T, Buttaro M, et al (2019) Hip and knee section, what is the definition of a periprosthetic joint infection (PJI) of the knee and the hip? can the same criteria be used for both joints? proceedings of international consensus on orthopedic infections. J Arthroplasty, 34:S325–S327

  3. Zahar A, Klaber I, Gerken AM et al (2019) Ten-year results following one-stage septic hip exchange in the management of periprosthetic joint infection. J Arthroplasty 34:1221–1226. https://doi.org/10.1016/j.arth.2019.02.021

    Article  PubMed  Google Scholar 

  4. Leonard HAC, Liddle AD, Burke Ó et al (2014) Single- or two-stage revision for infected total hip arthroplasty? A systematic review of the literature. Clin Orthop Relat Res 472:1036–1042. https://doi.org/10.1007/s11999-013-3294-y

    Article  PubMed  Google Scholar 

  5. Gehrke T, Zahar A, Kendoff D (2013) One-stage exchange: it all began here. Bone Jt J. https://doi.org/10.1302/0301-620X.95B11.32646

    Article  Google Scholar 

  6. Fink B, Makowiak C, Fuerst M et al (2008) The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. J Bone Jt Surg Ser B 90:874–878. https://doi.org/10.1302/0301-620X.90B7.20417

    Article  CAS  Google Scholar 

  7. Qu X, Zhai Z, Wu C et al (2013) Preoperative aspiration culture for preoperative diagnosis of infection in total hip or knee arthroplasty. J Clin Microbiol 51:3830–3834. https://doi.org/10.1128/JCM.01467-13

    Article  PubMed  PubMed Central  Google Scholar 

  8. Cross MC, Kransdorf MJ, Chivers FS et al (2014) Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty. Skeletal Radiol 43:165–168. https://doi.org/10.1007/s00256-013-1757-6

    Article  PubMed  Google Scholar 

  9. Dilisio MF, Miller LR, Warner JJP, Higgins LD (2014) Arthroscopic tissue culture for the evaluation of periprosthetic shoulder infection. J Bone Jt Surg Am 96:1952–1958. https://doi.org/10.2106/JBJS.M.01512

    Article  Google Scholar 

  10. Fink B, Gebhard A, Fuerst M et al (2013) High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip infection. Clin Orthop Relat Res 471:956–964. https://doi.org/10.1007/s11999-012-2474-5

    Article  PubMed  Google Scholar 

  11. Malhotra R, Morgan DAF (2004) Role of core biopsy in diagnosing infection before revision hip arthroplasty. J Arthroplasty. https://doi.org/10.1016/S0883-5403(03)00453-4

    Article  PubMed  Google Scholar 

  12. Krenn V, Morawietz L, Perino G et al (2014) Revised histopathological consensus classification of joint implant related pathology. Pathol Res Pract 210:779–786. https://doi.org/10.1016/j.prp.2014.09.017

    Article  CAS  PubMed  Google Scholar 

  13. Gomez E, Cazanave C, Cunningham SA et al (2012) Prosthetic joint infection diagnosis using broad-range PCR of biofilms dislodged from knee and hip arthroplasty surfaces using sonication. J Clin Microbiol. https://doi.org/10.1128/JCM.00834-12

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gallo J, Kolar M, Dendis M et al (2008) Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection. New Microbiol 31(1):97–104

    PubMed  Google Scholar 

  15. Spangehl MJ, Masri BA, O’Connell JX, Duncan CP (1999) Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties. J Bone Jt Surg Ser A. https://doi.org/10.2106/00004623-199905000-00008

    Article  Google Scholar 

  16. Pohlig F, Mühlhofer HML, Lenze U et al (2017) Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip. Eur J Med Res. https://doi.org/10.1186/s40001-017-0246-0

    Article  PubMed  PubMed Central  Google Scholar 

  17. Fink B, Schuster P, Braun R et al (2020) The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty. Bone Jt J. https://doi.org/10.1302/0301-620X.102B3.BJJ-2019-0684.R1

    Article  Google Scholar 

  18. Gehrke T, Kendoff D (2012) Peri-prosthetic hip infections: in favour of one-stage. Hip Int. https://doi.org/10.5301/HIP.2012.9569

    Article  PubMed  Google Scholar 

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Author notes

  1. Ianiv Klaber and Fabian Scholz have contributed equally in writing this article.

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Helios ENDO-Klinik Hamburg, Holstenstraße 2, 22767, Hamburg, Germany

    Ianiv Klaber, Fabian Scholz, Mustafa Citak, Thorsten Gehrke & Christian Lausmann

  2. Department of Orthopedic Surgery, Pontificia Universidad Catolica de Chile, Santiago, Chile

    Ianiv Klaber

  3. Department of Orthopaedic Surgery and Traumatology, Helios Klinikum Emil von Behring, Berlin, Germany

    Akos Zahar

  4. Department of Orthopaedic Surgery, AMEOS Klinikum Seepark, Geestland, Germany

    Carl Haasper

  5. Department of Trauma Surgery, Hannover Medical School, Hannover, Germany

    Nael Hawi

Authors
  1. Ianiv Klaber
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  2. Fabian Scholz
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  3. Mustafa Citak
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  8. Christian Lausmann
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Corresponding author

Correspondence to Christian Lausmann.

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Conflict of interest

The authors declare that they have no conflict of interest regarding this manuscript. Outside the manuscript, one or more of the authors of this paper have disclosed the following disclosures: Waldemar Link, Hamburg, Germany. Zimmer Biomed. Ceramtec.

Ethical approval

This study was performed after obtaining approval from the institutional review board. The corresponding number is WF-033/19.

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Klaber, I., Scholz, F., Citak, M. et al. Diagnostic utility of open biopsy in patients with two culture-negative aspirations in the diagnostic work-up of periprosthetic joint infection. Arch Orthop Trauma Surg 143, 749–754 (2023). https://doi.org/10.1007/s00402-021-04142-1

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  • DOI: https://doi.org/10.1007/s00402-021-04142-1

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