Abstract
Aim
Synovial sampling can be used in the diagnosis of peri-prosthetic joint infection (PJI). The purpose of this study was to establish the role of simultaneous image-guided synovial aspiration and biopsy (SAB) during an initial 2-year experience at our institution.
Methods
Retrospective review of consecutive SABs performed during 2014–2016 at a tertiary referral musculoskeletal centre. Radiological SAB microbiology culture results were compared with intra-operative surgical samples or multidisciplinary team (MDT) meeting outcome at 1-year follow-up if surgery was not undertaken. Sensitivity, specificity and accuracy of synovial aspiration (SA), synovial biopsy (SB) and simultaneous SAB were calculated.
Results
103 patients (46 male, 57 female) totalling 111 procedures were analysed with mean age 65 years (range 31–83). Image-guided synovial procedures were performed on 52 (46.9%) hip and 59 (53.1%) knee joint prostheses. The mean combined sensitivity, specificity and accuracy for the entire cohort was 72.6%, 96.9% and 90%, respectively. When only SB was obtained, diagnostic accuracy (92.5%) was similar to SA alone (94.1%). In total, there were 21 (18.9%) true-positive, 80 (72.1%) true-negative, 2 (1.8%) false-positive and 8 (7.2%) false-negative cases (PPV 91.3% and NPV 90.9%). No post-procedural complications were recorded at 1-year follow-up.
Conclusion
Percutaneous image-guided SAB is a valuable technique in assessing suspected PJI, with most samples indicative of infective status and causative organisms when validated against intra-operative results and specialist MDT evaluation. Image-guided SB is a safe and useful additional procedure following failed SA with equivalent levels of diagnostic accuracy.
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Acknowledgements
The authors would like to thank all members of the Joint Replacement Unit Infection MDT at the Royal National Orthopaedic Hospital, Stanmore, comprising nursing and administrative colleagues, orthopaedic surgeons, microbiologists and radiologists. The authors would also like to extend thanks to Dr Peter Munk and Dr Hugue Ouellette (Vancouver General Hospital, University of British Columbia) for identifying the potential benefits of percutaneous synovial biopsy at the time of synovial aspiration using co-axial interventional radiology techniques.
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Rajakulasingam, R., Cleaver, L., Khoo, M. et al. Introducing image-guided synovial aspiration and biopsy in assessing peri-prosthetic joint infection: an early single-centre experience. Skeletal Radiol 50, 2031–2040 (2021). https://doi.org/10.1007/s00256-021-03774-z
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DOI: https://doi.org/10.1007/s00256-021-03774-z