Low Diagnostic Value of Synovial Aspiration Culture Prior to Reimplantation in Periprosthetic Joint Infection

Background/Aim: We aimed to determine the diagnostic value of the synovial aspiration culture prior to reimplantation in two- (or more) stage exchange of periprosthetic joint infection. Patients and Methods: This was a retrospective study, spanning over ten years including all synovial cultures of patients with two- (or more) stage exchange due to periprosthetic joint infection. Results: A total of 183 patients were included, mean age was 66.6 years (range=12.8-93.4 years). Overall sensitivity of synovial aspiration cultures before reimplantation was 56.6%, specificity 84.6%, negative predictive value (NPV) 63.8%, positive predictive value (PPV) 80.2%, area under the curve (AUC) 70.6%. Sensitivity of the knee in comparison to the hip culture was significantly higher, as well as the NPV and the AUC (p=0.038). In case of complete removal of prosthesis, the sensitivity and AUC were significantly reduced, whereas the specificity was comparable with prosthesis in situ, partial removal or complete removal. Conclusion: Due to the low sensitivity, obtaining several synovial cultures in the prosthesis-free interval to exclude persistence of infection, does not seem reasonable.

[1]  Á. Soriano,et al.  Is Gram staining still useful in prosthetic joint infections? , 2019, Journal of bone and joint infection.

[2]  C. Abad,et al.  Prosthetic Joint Infections: an Update , 2018, Current Infectious Disease Reports.

[3]  C. Perka,et al.  Synovial fluid multiplex PCR is superior to culture for detection of low-virulent pathogens causing periprosthetic joint infection. , 2018, Diagnostic microbiology and infectious disease.

[4]  T. Peel,et al.  Prosthetic Joint Infections , 2018, Springer International Publishing.

[5]  J. Esteban,et al.  Evaluation of the use of sonication of retrieved implants for the diagnosis of prosthetic joint infection in a routine setting , 2017, European Journal of Clinical Microbiology & Infectious Diseases.

[6]  P. Eysel,et al.  Periprosthetic Infection in Joint Replacement. , 2017, Deutsches Arzteblatt international.

[7]  G. Wassilew,et al.  Validation of Synovial Aspiration in Girdlestone Hips for Detection of Infection Persistence in Patients Undergoing 2-Stage Revision Total Hip Arthroplasty. , 2016, The Journal of arthroplasty.

[8]  Robin Patel,et al.  Evaluation of a Genus- and Group-Specific Rapid PCR Assay Panel on Synovial Fluid for Diagnosis of Prosthetic Knee Infection , 2015, Journal of Clinical Microbiology.

[9]  G. Wassilew,et al.  Improved identification of polymicrobial infection in total knee arthroplasty through sonicate fluid cultures , 2013, Archives of Orthopaedic and Trauma Surgery.

[10]  Robin Patel,et al.  Low sensitivity of periprosthetic tissue PCR for prosthetic knee infection diagnosis. , 2014, Diagnostic microbiology and infectious disease.

[11]  C. Perka,et al.  [Periprosthetic infection after hip arthroplasty]. , 2014, Der Orthopade.

[12]  C. Perka,et al.  Improvement in the detection rate of PJI in total hip arthroplasty through multiple sonicate fluid cultures , 2013, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[13]  M. Mariconda,et al.  Sonication of antibiotic-loaded cement spacers in a two-stage revision protocol for infected joint arthroplasty , 2013, BMC Musculoskeletal Disorders.

[14]  Robin Patel,et al.  Rapid Molecular Microbiologic Diagnosis of Prosthetic Joint Infection , 2013, Journal of Clinical Microbiology.

[15]  G. Wassilew,et al.  Evaluation of sonicate fluid cultures in comparison to histological analysis of the periprosthetic membrane for the detection of periprosthetic joint infection , 2013, International Orthopaedics.

[16]  Robin Patel,et al.  Prosthetic Joint Infection Diagnosis Using Broad-Range PCR of Biofilms Dislodged from Knee and Hip Arthroplasty Surfaces Using Sonication , 2012, Journal of Clinical Microbiology.

[17]  P. Bejon,et al.  Microbiological diagnosis of prosthetic joint infections: a prospective evaluation of four bacterial culture media in the routine laboratory. , 2011, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[18]  Christina L. Jacovides,et al.  Definition of Periprosthetic Joint Infection: Is There a Consensus? , 2011, Clinical orthopaedics and related research.

[19]  C. Perka,et al.  Validity of Frozen Sections for Analysis of Periprosthetic Loosening Membranes , 2010, Clinical orthopaedics and related research.

[20]  C. Perka,et al.  [Histopathological diagnosis of periprosthetic joint infection following total hip arthroplasty : use of a standardized classification system of the periprosthetic interface membrane]. , 2009, Der Orthopade.

[21]  W. Zimmerli,et al.  Diagnosis and treatment of implant-associated septic arthritis and osteomyelitis , 2008, Current infectious disease reports.

[22]  L. Frommelt,et al.  The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements. , 2008, The Journal of bone and joint surgery. British volume.

[23]  L. Frommelt.  [Aspiration of joint fluid for detection of the pathogen in periprosthetic infection]. , 2008, Der Orthopade.

[24]  P. Sauer,et al.  Culture and PCR analysis of joint fluid in the diagnosis of prosthetic joint infection. , 2008, The new microbiologica.

[25]  C. Lohmann,et al.  [The treatment of periprosthetic infections]. , 2007, Zeitschrift fur Rheumatologie.

[26]  L. Frommelt,et al.  Proposal for a histopathological consensus classification of the periprosthetic interface membrane , 2006, Journal of Clinical Pathology.

[27]  W. Zimmerli,et al.  Infection and musculoskeletal conditions: Prosthetic-joint-associated infections. , 2006, Best practice & research. Clinical rheumatology.

[28]  K. Bozic,et al.  The impact of infection after total hip arthroplasty on hospital and surgeon resource utilization. , 2005, The Journal of bone and joint surgery. American volume.

[29]  B. Fink,et al.  [The value of preoperative knee aspiration and arthroscopic biopsy in revision total knee arthroplasty]. , 2005, Zeitschrift fur Orthopadie und ihre Grenzgebiete.

[30]  L. Frommelt,et al.  [Proposal for the classification of the periprosthetic membrane from loosened hip and knee endoprostheses]. , 2004, Der Pathologe.

[31]  I. Stockley,et al.  The value of hip aspiration versus tissue biopsy in diagnosing infection before exchange hip arthroplasty surgery. , 2004, The Journal of arthroplasty.

[32]  H. Hossain,et al.  [Infection diagnosis after knee-TEP-implantation]. , 2004, Zeitschrift fur Orthopadie und ihre Grenzgebiete.

[33]  O. Meurman,et al.  The Reliability of Diagnosis of Infection during Revision Arthroplasties , 2002, Scandinavian journal of surgery : SJS : official organ for the Finnish Surgical Society and the Scandinavian Surgical Society.

[34]  D. Haas,et al.  Sequential Indium-Labeled Leukocyte and Bone Scans to Diagnose Prosthetic Joint Infection , 2000, Clinical orthopaedics and related research.

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

[36]  S. Kelley,et al.  Aspiration of the Knee Joint Before Revision Arthroplasty , 1996, Clinical orthopaedics and related research.

[37]  L. K. Harding,et al.  White cell scans and infected joint replacements. Failure to detect chronic infection. , 1993, The Journal of bone and joint surgery. British volume.

[38]  R. Balderston,et al.  Evaluation of the painful prosthetic joint. Relative value of bone scan, sedimentation rate, and joint aspiration. , 1991, The Journal of arthroplasty.

[39]  J. Kaye,et al.  Detection of occult infection following total joint arthroplasty using sequential technetium-99m HDP bone scintigraphy and indium-111 WBC imaging. , 1988, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.