Accuracy of diagnostic tests for prosthetic joint infection: a systematic review

Ahmad, Sufian S.; Shaker, Ahmed; Saffarini, Mo; Chen, Antonia F.; Hirschmann, Michael T.; Kohl, Sandro

doi:10.1007/s00167-016-4230-y

Cited by 56 publications

(50 citation statements)

References 55 publications

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“…Thus, biofilm formation may be an explanation for the poor results of SFC. Accordingly, the indirect means of persistent infection detection such as SLC had a higher sensitivity, a fact known for primary PJI diagnosis [ 9 , 10 ]. In comparison to the categorical SFC, the cut-off value of the metric SLC can be leveled up or down.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Boelch¹,

Weißenberger²,

Spohn³

et al. 2018

J Orthop Surg Res

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BackgroundEvaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated.MethodsNinety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed.ResultsThe sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671).ConclusionsSynovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.

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Section: Discussionmentioning

confidence: 99%

“…At the hip, sensitivity of synovial fluid culture (SFC) has shown a wide range between 44 and 80%. Sensitivity of synovial leucocyte count (SLC) seems to be higher with 82 to 96% [ 10 – 12 ]. However, although data is very limited, the diagnostic value of IA seems to be worse [ 13 ].…”

Section: Introductionmentioning

confidence: 99%

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Boelch¹,

Weißenberger²,

Spohn³

et al. 2018

J Orthop Surg Res

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“…Dennoch liegt bislang kein Konsens bez. eines standardisierten Algorithmus vor, und einzelne Elemente der präoperativen Diagnostik werden in der Literatur kontrovers diskutiert [17,42,43]. Hierbei sei angemerkt, dass vorliegende Studien und Algorithmen ihre Erkenntnisse i. d. R. aus retrospektiven Datenanalysen ziehen [21,25,44,45].…”

Section: Operative Zupfbiopsieunclassified

Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee – Evaluation of an Evidence-based Algorithm

et al. 2019

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Background Periprosthetic joint infection (PPI) is one of the most common reasons for revision in total knee arthroplasty (TKA). Percutaneous synovial biopsy is considered as a well-established diagnostic tool in ambiguous cases of chronic pain after TKA. The exact number of undetected low-grade infections remains unclear. Objectives The aim of this prospective study was to compare the diagnostic accuracy of arthroscopically guided and unguided synovial biopsy. Additionally, the prevalence of initially undetected PPI during synovial biopsy and revision surgery was assessed. Materials and Methods 40 patients suffering from chronic pain after TKA and the clinical suspicion of PPI were included in the study. Synovial biopsies were collected in a standardized manner first without and then with arthroscopic visual control. Using both techniques, six samples were collected each (5 for microbiology, 1 for histology). 19 patients, initially classified aseptic, underwent revision surgery later. Results The diagnosis of PPI was made in 10.0% of unguided biopsies (4 cases, 2× microbiologically, 2× histologically), 7.5% of arthroscopic biopsies (3 cases, 3× histologically) and 12.5% (5 cases, 3× histologically, 2× microbiologically) of all cases. Only histologic evaluation led to concordant positive findings using both techniques in two patients. The proportion of non-representative biopsies was twice as high after unguided tissue collection than after arthroscopic biopsy (30.0 vs. 15.0%). Microbiologic evaluation of arthroscopically collected biopsies did not lead to the diagnosis of PPI, which might have been essential to the selection of the appropriate antimicrobial therapy. During revision surgery the diagnosis of PPI was made in 22.2% of cases. Conclusions In patients suffering from chronic pain after TKA, periprosthetic low-grade infection was diagnosed in a relevant proportion of cases. Therefore, synovial biopsies for histological and microbiological evaluation should be collected whenever thereʼs clinical suspicion of PPI. For histological evaluation, samples should be collected using arthroscopic control and ideally multiple biopsies should be taken. For microbiological evaluation, excessive joint lavage should be avoided.

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“…2 Differentiating PJI from sterile inflammation in the postoperative period remains a challenge for contemporary diagnostic techniques, such as commonly used imaging modalities, laboratory tests, and bacterial cultures. 5 Noninvasive imaging modalities are attractive options, as they offer the potential for diagnosing, monitoring, and assessing treatment longitudinally if sufficient sensitivity and resolution can be achieved. X-ray and magnetic resonance imaging (MRI) reveal gross morphological changes but unfortunately produce implant-related artifacts (especially involving metallic implants) that obscure relevant changes in the surrounding tissue.…”

Section: Introductionmentioning

confidence: 99%

Molecularly specific detection of bacterial lipoteichoic acid for diagnosis of prosthetic joint infection of the bone

Pickett

Thompson

Sadowska³

et al. 2018

Bone Res

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Discriminating sterile inflammation from infection, especially in cases of aseptic loosening versus an actual prosthetic joint infection, is challenging and has significant treatment implications. Our goal was to evaluate a novel human monoclonal antibody (mAb) probe directed against the Gram-positive bacterial surface molecule lipoteichoic acid (LTA). Specificity and affinity were assessed in vitro. We then radiolabeled the anti-LTA mAb and evaluated its effectiveness as a diagnostic imaging tool for detecting infection via immunoPET imaging in an in vivo mouse model of prosthetic joint infection (PJI). In vitro and ex vivo binding of the anti-LTA mAb to pathogenic bacteria was measured with Octet, ELISA, and flow cytometry. The in vivo PJI mouse model was assessed using traditional imaging modalities, including positron emission tomography (PET) with [18F]FDG and [18F]NaF as well as X-ray computed tomography (CT), before being evaluated with the zirconium-89-labeled antibody specific for LTA ([89Zr]SAC55). The anti-LTA mAb exhibited specific binding in vitro to LTA-expressing bacteria. Results from imaging showed that our model could reliably simulate infection at the surgical site by bioluminescent imaging, conventional PET tracer imaging, and bone morphological changes by CT. One day following injection of both the radiolabeled anti-LTA and isotype control antibodies, the anti-LTA antibody demonstrated significantly greater (P < 0.05) uptake at S. aureus-infected prosthesis sites over either the same antibody at sterile prosthesis sites or of control non-specific antibody at infected prosthesis sites. Taken together, the radiolabeled anti-LTA mAb, [89Zr]SAC55, may serve as a valuable diagnostic molecular imaging probe to help distinguish between sterile inflammation and infection in the setting of PJI. Future studies are needed to determine whether these findings will translate to human PJI.

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Accuracy of diagnostic tests for prosthetic joint infection: a systematic review

Abstract: Systematic review, Level IV.

Cited by 56 publications

References 55 publications

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee – Evaluation of an Evidence-based Algorithm

Molecularly specific detection of bacterial lipoteichoic acid for diagnosis of prosthetic joint infection of the bone

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