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Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty

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Abstract

Objective

To determine the accuracy of guided computed tomography aspiration in the detection of septic hip prosthesis before surgery.

Materials and Methods

Sixty-three patients (35 women and 28 men; age range, 29–86 years; mean age, 71 years) with clinically suspected septic hip prosthesis were prospectively studied with independent review board (IRB) approval. Volume and microbiological cultures of aspirated fluid and several computed tomography imaging findings such as periprosthetic fluid collections, prosthetic acetabular malposition, and heterotopic ossification were analyzed. All patients underwent revision surgery and infection was finally diagnosed in 33 patients.

Results

Statistical comparative analysis was performed comparing computed tomography aspiration and surgical findings (95% CI; level of significance at P = 0.05 two-sided) with 70% sensitivity, 100% specificity, 84% accuracy, 100% positive predictive value, and 75% negative predictive value. Using Fisher’s exact test, the presence of periprosthetic fluid collections (P = 0.001), prosthetic acetabular malposition (P = 0.025) and aspirated fluid volume (P = 0.009) were significantly higher in infected than in non-infected prostheses, whereas heterotopic ossification was not (P = 0.429).

Conclusion

Computed tomography aspiration is accurate to preoperatively diagnose septic hip prosthesis on the basis of volume and bacterial cultures of aspirated joint fluid. Furthermore, imaging findings such as periprosthetic fluid collections and prosthetic acetabular malposition strongly suggest infected prosthesis.

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Acknowledgements

To Enrique Jorcano, Ernesto Espinoso, and Alex Budoy, TER/ATS, of the CT, Radiology Department. To Ines Villagrasa, for her assistance with CT coordination. To Donna Pringle and Jennifer Brickman, for their help with English proof-reading.

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Authors and Affiliations

  1. Department of Radiology, Hospital Clinic, Universidad de Barcelona, Villarroel 170, Barcelona, 08036, Spain

    Xavier Tomas, Ana Isabel Garcia-Diez & Jaime Pomes

  2. Department of Orthopaedics, Hospital Clinic, Universidad de Barcelona, Villarroel 170, Barcelona, 08036, Spain

    Guillem Bori, Sebastián Garcia, Xavier Gallart, Juan Carlos Martinez & Josep Riba

  3. Department of Infectious Diseases, Hospital Clinic, Universidad de Barcelona, Villarroel 170, Barcelona, 08036, Spain

    Alex Soriano & Josep Mensa

  4. Statistical Unit de Suport a la Estadística I Metodología IDIBAPS, Rossello, 138 (UASP), Barcelona, 08036, Spain

    Jose Ríos

  5. Department of Microbiology, Hospital Clinic, Universidad de Barcelona, Villarroel 170, Barcelona, 08036, Spain

    Manel Almela

Authors
  1. Xavier Tomas
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  2. Guillem Bori
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  3. Sebastián Garcia
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  4. Ana Isabel Garcia-Diez
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  5. Jaime Pomes
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  6. Alex Soriano
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  7. Jose Ríos
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  8. Manel Almela
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  9. Josep Mensa
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  10. Xavier Gallart
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  11. Juan Carlos Martinez
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  12. Josep Riba
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Corresponding author

Correspondence to Xavier Tomas.

Additional information

This study won the Tecres Award attributed to the Best Poster at the 27th Annual Meeting of the European Bone and Joint Infection Society, 2008

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Tomas, X., Bori, G., Garcia, S. et al. Accuracy of CT-guided joint aspiration in patients with suspected infection status post-total hip arthroplasty. Skeletal Radiol 40, 57–64 (2011). https://doi.org/10.1007/s00256-010-0940-2

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  • DOI: https://doi.org/10.1007/s00256-010-0940-2

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