Saline Solution Lavage and Reaspiration for Culture with a Blood Culture System Is a Feasible Method for Diagnosing Periprosthetic Joint Infection in Patients with Insufficient Synovial Fluid.

BACKGROUND Culture is a key step for detecting periprosthetic joint infection (PJI) before surgery. However, using saline solution lavage and reaspiration in patients with insufficient synovial fluid remains controversial. The objective of this study was to evaluate this technique. METHODS This study included 286 aspirations performed by 1 surgeon in patients after total joint arthroplasty during the period of April 2015 to August 2018. If >1.0 mL of synovial fluid was obtained, then we directly used the fluid for culture. For cases in which ≤1.0 mL of synovial fluid was aspirated, 10 mL of saline solution was injected and the joint was reaspirated for culture. The samples were injected into 2 blood culture bottles for anaerobic bacterial culture and aerobic bacterial and fungal culture, and were inoculated for 14 days in a BACT/ALERT 3D blood culture system unless microorganisms were detected. A PJI diagnosis was determined on the basis of the modified Musculoskeletal Infection Society criteria. RESULTS Saline solution lavage and reaspiration were used in 82 cases (47 PJI cases and 35 non-PJI cases), while direct aspiration was used in 204 cases (99 PJI cases and 105 non-PJI cases). The overall rate for the use of saline solution lavage was 28.7% (82 of 286). Among knee cases, the saline solution lavage rate was 15.0% (21 of 140), and among hip cases, the rate was 41.8% (61 of 146). The overall sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of culture were 0.795 (95% confidence interval [CI], 0.720 to 0.857), 0.957 (95% CI, 0.909 to 0.984), 0.951 (95% CI, 0.896 to 0.982), and 0.817 (95% CI, 0.749 to 0.873); and for "dry tap" cases, they were 0.851 (95% CI, 0.717 to 0.938), 0.857 (95% CI, 0.697 to 0.952), 0.889 (95% CI, 0.760 to 0.963), and 0.811 (95% CI, 0.648 to 0.920), respectively. CONCLUSIONS Saline solution lavage and reaspiration for culture in patients with insufficient synovial fluid before surgery may be a sound practice. LEVEL OF EVIDENCE Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

[1]  I. Stockley,et al.  Joint aspiration, including culture of reaspirated saline after a ‘dry tap', is sensitive and specific for the diagnosis of hip and knee prosthetic joint infection , 2018, The bone & joint journal.

[2]  J. Parvizi,et al.  The 2018 Definition of Periprosthetic Hip and Knee Infection: An Evidence-Based and Validated Criteria. , 2018, The Journal of arthroplasty.

[3]  G. Wassilew,et al.  Reduced culture time and improved isolation rate through culture of sonicate fluid in blood culture bottles. , 2017, Technology and health care : official journal of the European Society for Engineering and Medicine.

[4]  Robin Patel,et al.  Laboratory Workflow Analysis of Culture of Periprosthetic Tissues in Blood Culture Bottles , 2017, Journal of Clinical Microbiology.

[5]  W. Barsoum,et al.  What is the Diagnostic Accuracy of Aspirations Performed on Hips With Antibiotic Cement Spacers? , 2017, Clinical orthopaedics and related research.

[6]  B. Liabaud,et al.  Prospective Comparison of Blood Culture Bottles and Conventional Swabs for Microbial Identification of Suspected Periprosthetic Joint Infection. , 2016, The Journal of arthroplasty.

[7]  Robin Patel,et al.  Improved Diagnosis of Prosthetic Joint Infection by Culturing Periprosthetic Tissue Specimens in Blood Culture Bottles , 2016, mBio.

[8]  J. Parvizi,et al.  Diagnosis of Infected Total Hip Arthroplasty , 2015, Hip international : the journal of clinical and experimental research on hip pathology and therapy.

[9]  J. Parvizi,et al.  Definition of periprosthetic joint infection. , 2014, The Journal of arthroplasty.

[10]  X. Qu,et al.  Preoperative Aspiration Culture for Preoperative Diagnosis of Infection in Total Hip or Knee Arthroplasty , 2013, Journal of Clinical Microbiology.

[11]  H. Schønheyder,et al.  Optimizing culture methods for diagnosis of prosthetic joint infections: a summary of modifications and improvements reported since 1995. , 2012, Journal of medical microbiology.

[12]  C. Pigrau,et al.  Percutaneous interface biopsy in dry-aspiration cases of chronic periprosthetic joint infections: A technique for preoperative isolation of the infecting organism , 2012, International Orthopaedics.

[13]  Á. Soriano,et al.  Blood Culture Flasks for Culturing Synovial Fluid in Prosthetic Joint Infections , 2010, Clinical orthopaedics and related research.

[14]  I. Stockley,et al.  Accuracy of joint aspiration for the preoperative diagnosis of infection in total hip arthroplasty. , 2006, The Journal of arthroplasty.

[15]  R. Barrack,et al.  The Coventry Award. The value of preoperative aspiration before total knee revision. , 1997, Clinical orthopaedics and related research.

[16]  R. Barrack,et al.  The value of aspiration of the hip joint before revision total hip arthroplasty. , 1993, The Journal of bone and joint surgery. American volume.

[17]  P. Roberts,et al.  Diagnosing infection in hip replacements. The use of fine-needle aspiration and radiometric culture. , 1992, The Journal of bone and joint surgery. British volume.