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Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

Background

Successful treatment of an infected joint arthroplasty depends on correctly identifying the responsible pathogens. The value of a preoperative biopsy remains controversial.

Questions/purposes

We (1) compared the sensitivity and specificity of both tests separately and in combination, and (2) asked whether the combination of tissue biopsy and aspiration would improve our diagnostic yield in the evaluation of periprosthetic joint infections.

Patients and Methods

We prospectively followed 120 patients with suspected infection of a total joint arthroplasty: 64 with THAs and 56 with TKAs. All patients had aspiration with culture and biopsy.

Results

The sensitivity was 83% for aspiration, 79% for biopsy, and 90% for the combination of both techniques. The specificity was 100% for aspiration and biopsy and the combination. The overall accuracy was 84%, 81%, and 90%, respectively.

Conclusions

Our data suggest tissue biopsy alone offers no clear advantage over joint aspiration. However, the combination of both techniques provides improved sensitivity and accuracy. We recommend the use of tissue biopsy as an adjunct to joint aspiration in the diagnosis of total joint infection.

Level of Evidence

Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.

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Acknowledgments

We acknowledge the microbiologic support provided by Geoff Ridgeway, Geoff Scott, Vanya Gant, John Holton, and Bruce Macrae.

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Authors and Affiliations

  1. University College London Hospital, London, UK

    Geert Meermans MD & Fares S. Haddad BSc, MCh (Orth), FRCS (Orth)

  2. Marie-Josélaan 19, 2600, Berchem, Belgium

    Geert Meermans MD

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  1. Geert Meermans MD
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  2. Fares S. Haddad BSc, MCh (Orth), FRCS (Orth)
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Correspondence to Geert Meermans MD.

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Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

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Meermans, G., Haddad, F.S. Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?. Clin Orthop Relat Res 468, 1410–1417 (2010). https://doi.org/10.1007/s11999-010-1245-4

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