Advertisement

Skeletal Radiology

, Volume 43, Issue 2, pp 165–168 | Cite as

Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty

  • M. Connor Cross
  • Mark J. KransdorfEmail author
  • F. Spencer Chivers
  • Roxanne Lorans
  • Catherine C. Roberts
  • Adam J. Schwartz
  • Christopher P. Beauchamp
Scientific Article

Abstract

Purpose

Percutaneous synovial biopsy has recently been reported to have a high diagnostic value in the preoperative identification of periprosthetic infection of the hip. We report our experience with this technique in the evaluation of patients undergoing revision hip arthroplasty, comparing results of preoperative synovial biopsy with joint aspiration in identifying an infected hip arthroplasty by bacteriological analysis.

Materials and methods

We retrospectively reviewed the results of the 110 most recent revision hip arthroplasties in which preoperative synovial biopsy and joint aspiration were both performed. Revision surgery for these patients occurred during the period from September 2005 to March 2012. Using this study group, results from preoperative cultures were compared with preoperative laboratory studies and the results of intraoperative cultures. Synovial aspiration was done using an 18- or 20-gauge spinal needle. Synovial biopsy was done coaxially following aspiration using a 22-gauge Chiba needle or 21-gauge Sure-Cut needle. Standard microbiological analysis was performed on preoperative synovial fluid aspirate and synovial biopsy. Intraoperative tissue biopsy bacteriological analysis results at surgical revision were accepted as the “gold standard” for the presence or absence of infection.

Results

Seventeen of 110 (15 %) of patients had intraoperative culture-positive periprosthetic infection. Of these 17 cases, there were ten cases where either the synovial fluid aspiration and/or the synovial biopsy were true positive (sensitivity of 59 %, specificity of 100 %, positive predictive value of 100 % and accuracy of 94 %). There were seven cases where aspiration and biopsy results were both falsely negative, but no false-positive results. Similar results were found for synovial fluid aspiration alone. The results of synovial biopsy alone resulted in the identification of seven infected joints with no false-positive result (sensitivity of 41 %, specificity of 100 %, positive predictive value of 100 %, and accuracy of 91 %).

Conclusions

Standard microbiological analyses performed on percutaneous synovial biopsy specimen during the preoperative evaluation of patients undergoing revision hip arthroplasty did not improve detection of culture-positive periprosthetic infection as compared to synovial fluid aspiration alone.

Keywords

Percutaneous joint aspiration Synovial biopsy Arthroplasty Hip Prosthesis Infection Periprosthetic infection 

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Kurtz SM, Ong KL, Lau E, Bozic KJ, Berry D, Parvizi J. Prosthetic joint infection risk after TKA in the Medicare population. Clin Orthop Relat Res. 2010;468(1):52–6.PubMedCrossRefGoogle Scholar
  2. 2.
    Ong KL, Kurtz SM, Lau E, Bozic KJ, Berry DJ, Parvizi J. Prosthetic joint infection risk after total hip arthroplasty in the Medicare population. J Arthroplasty. 2009;24(6 Suppl):105–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Bozic KJ, Kurtz SM, Lau E, Ong K, Vail TP, Berry DJ. The epidemiology of revision total hip arthroplasty in the United States. J Bone Joint Surg Am. 2009;91(1):128–33.PubMedCrossRefGoogle Scholar
  4. 4.
    Della Valle C, Parvizi J, Bauer TW, Dicesare PE, Evans RP, Segreti J, et al. Diagnosis of periprosthetic joint infections of the hip and knee. J Am Acad Orthop Surg. 2010;18(12):760–70.PubMedGoogle Scholar
  5. 5.
    Fink B, Gebhard A, Fuerst M, Berger I, Schafer P. High diagnostic value of synovial biopsy in periprosthetic joint Infection of the hip. Clin Orthop Relat Res. 2012;471(3):956–64.Google Scholar
  6. 6.
    Fink B, Makowiak C, Fuerst M, Berger I, Schafer P, Frommelt L. 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 Joint Surg Br. 2008;90(7):874–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Pezzullo JC. Exact binomial and Poisson confidence intervals. http://statpages.org/confint.html.
  8. 8.
    Bauer TW, Parvizi J, Kobayashi N, Krebs V. Diagnosis of periprosthetic infection. J Bone Joint Surg Am. 2006;88(4):869–82.PubMedCrossRefGoogle Scholar
  9. 9.
    Parvizi J, Jacovides C, Zmistowski B, Jung KA. Definition of periprosthetic joint infection: is there a consensus? Clin Orthop Relat Res. 2011;469(11):3022–30.PubMedCrossRefGoogle Scholar
  10. 10.
    Schinsky MF, Della Valle CJ, Sporer SM, Paprosky WG. Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty. J Bone Joint Surg Am. 2008;90(9):1869–75.PubMedCrossRefGoogle Scholar
  11. 11.
    Spangehl MJ, Masri BA, O’Connell JX, Duncan CP. 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 Joint Surg Am. 1999;81(5):672–83.PubMedGoogle Scholar
  12. 12.
    Trampuz A, Piper KE, Jacobson MJ, Hanssen AD, Unni KK, Osmon DR, et al. Sonication of removed hip and knee prostheses for diagnosis of infection. N Engl J Med. 2007;357(7):654–63.PubMedCrossRefGoogle Scholar

Copyright information

© ISS 2013

Authors and Affiliations

  • M. Connor Cross
    • 1
    • 3
  • Mark J. Kransdorf
    • 1
    Email author
  • F. Spencer Chivers
    • 1
  • Roxanne Lorans
    • 1
  • Catherine C. Roberts
    • 1
  • Adam J. Schwartz
    • 2
  • Christopher P. Beauchamp
    • 2
  1. 1.Department of RadiologyMayo ClinicPhoenixUSA
  2. 2.Department of Orthopedic SurgeryMayo ClinicPhoenixUSA
  3. 3.TulsaUSA

Personalised recommendations