The place of arthrography for component loosening and hip aspiration for diagnosis of infection
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The aim of that study was to evaluate the place of arthrography for component loosening and of hip aspiration for diagnosing infection. 52 arthrograms were done under local anesthesia in radiology suites under fluoroscopic guidance. If no fluid was aspirated a non bacteriostatic saline solution was injected and reaspirated. Liquid was then analized. Component loosening was evaluated by plain films and by arthrography and compared to the surgical findings in all cases. The sensitivity of arthrography (94.5%) was better than that of plain films (83%) for evaluating socket loosening, but was worse (77%vs 92%) for femoral component evaluation. They were no false positive evaluations in socket loosening, but false negatives occurred in 2 cases with supporting material such as screws and plates. Results for femoral loosening are more difficult to analyse. The sensitivity (77%) and the specificity (81%) of arthrography are lower than plain films (92% and 88%). Most authors consider that the femoral component is loose when more than one third of the stem has a lucent line. 4 patients had such findings and were operated on. In each case the stem was found to be stable at operation. We removed the stem in two cases and left it in place in two old patients. We simply cleaned the granuloma from the proximal part of the femur. It means that arthrography did not really fail to make the diagnosis. But surgical procedures in case of incomplete radiolucent lines are not mandatory and depend on the individual surgeon's philosophy. Sensitivity of hip aspiration to identify periprosthetic germ was 66% and a specificity was 100%. No false positives were found. Only one patient over 41 without any sign of active infection had a positive hip aspiration. This test is not sensitive enough to be a prerequiste test before total hip revision but has to be done in cases of clinical or suspected sepsis.
Key wordsArthrography Second hip arthrography Hip aspiration Infection
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