Increased Diagnostic Certainty of Periprosthetic Joint Infections by Combining Microbiological Results with Histopathological Samples Gained via a Minimally Invasive Punching Technique

Abstract

Background: The diagnosis of low-grade infections of endoprostheses is challenging. There are still no unified guidelines for standardised diagnostic approaches, recommendations are categorised into major and minor criteria. Additional histopathological samples might sustain the diagnosis. However, ambulatory preoperative biopsy collection is not widespread. Method: 102 patients with hip or knee endoprosthesis and suspected periprosthetic joint infection (PJI) were examined by arthrocentesis with microbiological sample and histopathological punch biopsy. The data were retrospectively analysed for diagnosis concordance. Results: Preoperative microbiology compared to intraoperative results was positive in 51.9% (sensitivity 51.9%, specificity 97.3%). In comparison of preoperative biopsy to intraoperative diagnostic results 51.9% cases were positive (sensitivity 51.9%, specificity 100.0%). The combination of preoperative biopsy and microbiology in comparison to intraoperative results was positive in 70.4% of the cases (sensitivity 70.4%, specificity 97.3%). Conclusion: The diagnosis of PJI is complex. One single method to reliably detect an infection is currently not available. With the present method histopathological samples might be obtained quickly, easily and safely for the preoperative detection of PJI. A combination of microbiological and histopathological sampling increases the sensitivity up to 18.5% to detect periprosthetic infection.

Periprosthetic Fungal Infections in Severe Endoprosthetic Infections of the Hip and Knee Joint—A Retrospective Analysis of a Certified Arthroplasty Centre of Excellence

“…When then calculating the incidence of fungal PJIs based on the assumed number of PJIs, the 30 reported fungal PJIs would also amount to a percentage of 5.9% (30/512). While this is still lower than the values in the current study, where Candida species were isolated in approximately 12% of cases, the data here are in accordance with one of the previous studies by this centre, in which Candida species were isolated in 3 of 27 intraoperative samples of confirmed PJI [ 25 ]. The higher detection rates in this centre might be due to various reasons.…”

Individuelle Megaspacer für den zweizeitigen Wechsel infizierter Hüftendoprothesen – klinisches und funktionelles Outcome nach 2 Jahren

“…Die Diagnose einer PPI wurde in dieser Kohorte gemäß den Kriterien der Musculoskeletal Infection Society (MSIS 2014) gestellt [ 15 ]. Bei klinisch nicht offensichtlichem PPI erfolgte die präoperative Stanzbiopsie (Mikrobiologie, Histologie) mit Synovialzellanalyse und Beurteilung des Membrantyps nach Krenn/Morawietz [ 15 – 17 ]. Bei der Explantation wurden 2 histologische Proben sowie 6 mikrobiologische Proben (14 Tage Bebrütung) entnommen [ 18 ].…”

“…Aufgrund der erforderlichen Spacerintervalle von durchschnittlich 2,9 Monaten (Tab. 1 ) erfolgte vor der Reimplantation die Untersuchung (Klinik, Labor, Stanzbiopsie) hinsichtlich Infektzeichen mit mindestens 2 Wochen Abstand zur letzten Antibiotikagabe [ 17 ].…”

Histological evaluation of periprosthetic infection using HOES scale and CD15 expression analysis at the stage of the hip revision arthroplasty

“…Его стандартизация необходима для получения точных и воспроизводимых данных в комплексной клинической диагностике, при проведении сравнительных научных исследований и внесении сведений в регистры артроплас-тики [33]. Авторами ряда клинических работ установлено, что исследование образцов тканей, полученных интраоперационно либо в результате открытой биопсии, более информативно в сравнении с анализом аспирата или игольчатой биопсии [7,34,35,36]. Согласно действующим российским и международным клиническим рекомендациям, гистологическое исследование интраоперационных образцов внут рисуставных и околопротезных тканей является обязатель-ным при подозрении на ППИ [7,11,15,16,36,37].…”