Role of core biopsy in diagnosing infection before revision hip arthroplasty

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Abstract

A prerevision core biopsy from a failed hip joint was performed in 41 hips (38 patients) with a high index of suspicion for sepsis to determine its efficacy in diagnosing sepsis. Seven hips were known septic failures, and core biopsy was undertaken to confirm resolution of sepsis. Forty hips were revised, whereas 1 hip had excision of heterotopic bone. Cultures and permanent histologic sections were obtained during subsequent surgeries, and findings were compared with the results of core biopsy. The commonest organisms isolated were coagulase-negative staphylococci and Propionibacterium acne. In patients without a history of sepsis, core biopsy diagnosed infection with sensitivity of 80%, specificity of 100%, accuracy of 97%, and positive predictive value of 100% using histologic evidence of sepsis at revision as the standard. Core biopsy, however, had low sensitivity and accuracy in establishing resolution of infection in patients with a history of septic failure. Cultures from the aspirate had 44% sensitivity and positive predictive value of 57%. Core biopsy is useful for investigating failed arthroplasties with suspected sepsis. It has advantages of hip aspiration and allows examination of periprosthetic tissue histology. Its role in diagnosing resolution of infection in previously septic failures, however, is limited.

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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No benefits or funds were received in support of this study.

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