Role of core biopsy in diagnosing infection before revision hip arthroplasty☆
Section snippets
Patients and methods
We reviewed the results of core biopsy in a series of 38 patients (41 hips), 37 of whom (40 hips) underwent revision hip arthroplasty and 1 patient who had excision of heterotopic bone, between 1994 and 1998. There were 20 male and 18 female patients. The average age was 70 years (range, 41–86 years). The left hip was involved in 25 hips and the right in 16 hips. All patients presented clinically with severe pain and dysfunction. Indications for performing core biopsy are listed in Table 1.
Microbiological assay
The summary of findings in 41 hips is shown in Table 2. In 1 case (case 2), aspiration did not recover any fluid from the joint, but histologic examination suggested an aseptic process that was confirmed later by examination of tissue obtained at revision. Whereas fluid aspirated from the joint grew organisms in 7 cases, the positive cultures were noted in the enrichment broth only in 4 of them. Organism grown from culture of aspirate was identical to the organisms grown from cultures taken at
Discussion
The prerevision recognition of occult sepsis as the cause of loosening of implants is extremely important and useful. It enables the surgeon to plan the revision surgery and reduce the risk of failure. Accurate preoperative diagnosis of sepsis allows the surgeon to advise the patient of the appropriate alternative in management and the likelihood of success associated with each option.
The positive cultures obtained from the joint have been taken as the gold standard [6]. This is because it is
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Cited by (34)
Single vs 2-Stage Revision for the Treatment of Periprosthetic Joint Infection
2020, Journal of ArthroplastyCitation Excerpt :Synovial fluid obtained should be sent for a synovial fluid white blood cell (WBC) count, differential, and aerobic and anaerobic cultures [17]; fungal and acid-fast bacillus cultures are only sent if initial cultures are negative but other laboratory tests suggest PJI as routinely ordering these tests is low yield in our experience. There are many reports in literature attempting to define cutoff values for WBC count and percent polymorphic neutrophils (PMN) [18–27] in chronic PJI. The International Consensus on PJI recommends thresholds of WBC >3000 cells/μL and %PMN of 80% [28].
Puncture Protocol in the Diagnostic Work-Up of a Suspected Chronic Prosthetic Joint Infection of the Hip
2018, Journal of ArthroplastyCitation Excerpt :In 2 of the 16 ultrasound-guided biopsies, a false-positive result was found, but none in the surgical cohort (192 biopsies). Our results regarding the diagnostic accuracy of the preoperative biopsies for diagnosing a chronic PJI are in agreement with literature in which the sensitivity ranges between 80% and 90% and the specificity ranges between 90% and 100% [9,18,25–33]. To increase the homogeneity of our study population, we solely analyzed patients with a hip arthroplasty, but the same puncture protocol was used in our institution for knee (15 cases) and elbow (5 cases) arthroplasties in which the same diagnostic accuracy was demonstrated (data not shown).
Diagnosis of Periprosthetic Joint Infection
2014, Journal of ArthroplastyCitation Excerpt :As discussed above, these individual components are accurate markers of PJI. Biopsy of the joint has an established accuracy in diagnosing PJI [40–46]. Due to the invasive nature of this tool and the theoretical risk of contaminating a previously aseptic joint, pre-operative biopsy should be limited to those cases with a high probability of PJI with inconclusive aspirate results.
Leukocyte esterase reagent strips for the rapid diagnosis of periprosthetic joint infection
2012, Journal of ArthroplastyUtility of intraoperative frozen section histopathology in the diagnosis of periprosthetic joint infection: A systematic review and meta-analysis
2012, Journal of Bone and Joint SurgeryCitation Excerpt :It was obvious from the article and/or confirmed by the corresponding author that three of the studies contained patient data from other studies that had already been included, and these three studies were excluded. Four studies analyzed the diagnostic test performance of frozen sections with use of two different histopathology criteria; thirty sets of results from twenty-six studies were therefore eligible for meta-analysis12–16,27–47. The twenty-six studies involved 3269 patients undergoing revision arthroplasty, and 796 (24.3%) of these patients were confirmed to have a joint infection (see Appendix).
Low accuracy in preoperative tissue biopsies for diagnosing chronic periprosthetic joint infection: an observational retrospective single-centre study
2023, Journal of International Medical Research
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No benefits or funds were received in support of this study.