Abstract
Aim
Periprosthetic joint infection (PJI) is a devasting complication after total hip arthroplasty. Joint aspiration and preoperative biopsy can be helpful diagnostics for PJI. The aim of this study is to evaluate the diagnostic value of preoperative biopsies after inconclusive or dry tap aspiration of the hip in patients undergoing revision hip arthroplasty. Secondarily we will evaluate the diagnostic value of synovial fluid aspiration cultures and peroperative tissue cultures for diagnosing or ruling out PJI.
Methods
Patients who underwent diagnostic aspiration and subsequent preoperative biopsy and/or revision surgery between January 2015 and January 2024 were included in the study. Synovial fluid aspirations and tissue samples obtained from biopsy and revision surgery were interpreted using the European Bone and Joint Infection Society criteria for PJI and in close consultation with the microbiologist.
Results
207 Patients were included with 231 synovial fluid aspirations. Sensitivity and specificity of synovial fluid aspiration cultures were 76% and 98%. In 62 patients tissue biopsies were performed, of which 40 after a dry tap. The tissue biopsies after a dry tap aspiration had a sensitivity of 50.0% and a specificity of 95.8%. In 21% tissue biopsies led to the confirmation of PJI in patient with a high suspicion of PJI after dry tap aspiration. In patients with an inconclusive synovial fluid aspiration result the addition of tissue biopsies led to a change in treatment in 14%. In 212 cases revision surgery was performed, intraoperative tissue cultures had a sensitivity and specificity of 83.3% and 99.3%.
Conclusions
Diagnosing PJI can be troublesome, especially if synovial fluid aspiration provides a dry tap. Tissue biopsy cultures in patients with a high suspicion of PJI after dry tap aspiration is a feasible way to confirm PJI, in 21% of patients PJI could be confirmed after dry tap aspiration. Ruling out PJI by means of a biopsy after a dry tap aspiration is less successful due to its low sensitivity. Tissue biopsies after an inconclusive aspiration leads to clinically important treatment changes.
