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Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is the best?

  • MUSCULOSKELETAL RADIOLOGY
  • Published:
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Abstract

Background

Fluid samples obtained from an affected joint still play a central role in the diagnosis of periprosthetic joint infection (PJI). It is the only preoperative test able to discover the causative microbiological agent. In the hip, fluid aspiration can be performed through fluoroscopy, ultrasound, or, less commonly, computed tomography. However, there is still a lack of consensus on which method is preferable in terms of efficacy and costbenefit.

Purposes

We, therefore, asked whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI.

Methods

Between 2013 and 2016, 52 hip aspirations were performed on 49 patients with clinical, radiological, or serological suspicion of PJI, waiting for a revision surgery. The patients were divided in two groups: fluoroscopy- (n = 26) vs ultrasound-guided hip aspiration group (n = 26). These groups were also divided in control and infected patients. The criteria of MusculoSkeletal Infection Society (MSIS) were used, as gold standard, to define PJI.

Results

(1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30€) than fluoroscopic-guided aspiration (343.58€).

Conclusions

We concluded that ultrasound-guided hip aspiration could represent a valid, safe, and less expensive diagnostic alternative to fluoroscopic-guided aspiration in hip PJI.

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Acknowledgements

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Funding

The current study received no funding.

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Authors and Affiliations

  1. Hip Department, Orthopedics and Trauma V, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy

    Filippo Randelli & Marco Brioschi

  2. Department of Biomedical Sciences for Health, University of Milan, Piazza Malan 2, San. Donato Milanese, 20097, Milan, Italy

    Marco Brioschi & Pietro Randelli

  3. IRCCS Policlinico San Donato, Piazza Edmondo Malan 1, San. Donato Milanese, 20097, Milan, Italy

    Federico Ambrogi

  4. Radiology Department, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy

    Silvana Sdao & Alberto Aliprandi

Authors
  1. Filippo Randelli
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  2. Marco Brioschi
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  3. Pietro Randelli
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  4. Federico Ambrogi
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Correspondence to Marco Brioschi.

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All authors of this manuscript declare that they have no conflict of interest.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Investigation performed at Milan, Italy.

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Randelli, F., Brioschi, M., Randelli, P. et al. Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is the best?. Radiol med 123, 28–35 (2018). https://doi.org/10.1007/s11547-017-0811-1

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  • DOI: https://doi.org/10.1007/s11547-017-0811-1

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