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

Partridge, David G; Winnard, Christopher; Townsend, Robert; Cooper, Reginald R.; Stockley, I

doi:10.1302/0301-620x.100b6.bjj-2017-0970.r2

Cited by 48 publications

(22 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Furthermore, microbiological cultures from synovial fluid vary greatly in their accuracy in the identification of the causative pathogen in PJI depending on the underlying study. A range of sensitivities from 12 to 94% has been reported by Patridge et al 12 , complicating targeted antibiotic treatment.…”

Section: Introductionmentioning

confidence: 96%

Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection

Schwarze

Moellenbeck

Gosheger

et al. 2021

Sci Rep

View full text Add to dashboard Cite

The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the usefulness of biopsies in patients with inconclusive diagnostic findings. We retrospectively identified 63 patients who underwent incisional biopsy for chronic PJI in the operation theatre following TKA revision between 2010 and 2018 after inconclusive preoperative diagnostics for PJI. In all cases, 5 independent biopsies were taken. Results from open biopsy for PJI were analyzed for diagnostic accuracy using the intraoperative results from following revision surgery as gold standard. 27 patients (43%) had a positive culture taken during biopsy. 15 cases (24%) met the diagnostic criteria for a chronic PJI. Most common organisms were Coagulase-negative staphylococci (67%) and Cutibacterium acnes (30%). Compared to the findings during revision surgery, biopsies showed a sensitivity of 47% and a specificity of 77% for PJI. Open incisional biopsy following inconclusive serum- and synovial diagnostics for low grade PJI may be considered for identification of microorganisms. Due to its low sensitivity and moderate specificity found in the present cohort, microbiological analysis should be combined with additional diagnostic markers and histological investigation.Level of Evidence. Retrospective cohort study (Level III).

show abstract

Section: Introductionmentioning

confidence: 96%

Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection

Schwarze

Moellenbeck

Gosheger

et al. 2021

Sci Rep

View full text Add to dashboard Cite

show abstract

“…If an insufficient amount of liquid is found, saline injection and subsequent reaspiration may be a useful technique. 15 Naturally, if such a technique is used microbiology is the only feasible investigation. Although a positive Gram stain result may still be considered useful information, it should never be used to rule out infection as it has been shown to have very low sensitivity.…”

Section: Native and Prosthetic Joint Infectionmentioning

confidence: 99%

Optimal microbiological sampling for the diagnosis of osteoarticular infection

et al. 2021

View full text Add to dashboard Cite

Infection is a dire complication afflicting every field of orthopaedics and traumatology. If specific clinical, laboratory and imaging parameters are present, infection is often assumed even in the absence of microbiological confirmation. However, apart from confirming infection, knowing the exact infecting pathogen(s) and their antimicrobial susceptibility patterns is paramount to help guide treatment. Every effort should therefore be undertaken with that goal in mind. Not all microbiological findings carry the same relevance, and knowing exactly how and where a sample was collected is key. Several different sampling techniques are available, and one must be aware of both advantages and limitations. Microbiological sampling alternatives in some of the most common clinical scenarios such as native and prosthetic joint infections, osteomyelitis and fracture-related infections, spinal and diabetic foot infections will be discussed. Orthopaedic surgeons should also be aware of basic laboratory sample processing techniques as they have a direct impact on the way specimens should be dealt with and transported to the laboratory. Only by knowing these basic principles will surgeons be able to participate in the multidisciplinary discussion and decision making around how to interpret microbiological findings in each specific patient. Cite this article: EFORT Open Rev 2021;6:390-398. DOI: 10.1302/2058-5241.6.210011

show abstract

“…Infection burden for all hip replacements in England is reported to be 1.6 % when there is high-quality post-discharge surveillance (Tanner et al, 2013). There is no one gold standard test for PJI: the difficulty in defining it has been much discussed (Parvizi et al, 2011(Parvizi et al, , 2013 and has led to the development of multi-test diagnostic criteria (Parvizi et al, 2018). Diagnoses are currently informed by several factors such as the clinical picture, pre-operative indicators such as blood tests (C-reactive protein, CRP, and erythrocyte sedimentation rate, ESR) and synovial fluid tests (Parvizi et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Hip aspiration culture: analysing data from a single operator series investigating periprosthetic joint infection

Barker

Marriot

Khan

et al. 2021

J. Bone Joint Infect.

View full text Add to dashboard Cite

Abstract. Introduction: We undertook this study to know the sensitivity, specificity and post-test probabilities of hip aspiration when diagnosing periprosthetic hip infections. We also examined “dry tap” (injection with saline and aspiration) results and aspiration volumes. Methods: This is a retrospective cohort study of patients aspirated for suspected periprosthetic joint infection between July 2012 and October 2016. All aspirations were carried out by one trained surgical care practitioner (SCP). All aspirations followed an aseptic technique and fluoroscopic guidance. Aspiration was compared to tissue biopsy taken at revision. Aspiration volumes were analysed for comparison. Results: Between January 2012 and September 2016, 461 hip aspirations were performed by our SCP. Of these 125 progressed to revision. We calculated sensitivity 59 % (confidence interval (CI) 35 %–82 %) and specificity 94 % (CI 89 %–98 %). Pre-test probability for our cohort was 0.14. Positive post-test probability was 0.59 and negative post-test probability 0.06. Aspiration volume for infected (n=17) and non-infected (n=108) joints was compared and showed no significant difference. Dry taps were experienced five times; in each instance the dry tap agreed with the biopsy result. Conclusions: Our data show that hip aspiration culture is a highly specific investigation for diagnosing infection but that it is not sensitive. Aspiration volume showed no significant difference between infected and non-infected groups. Each time a joint was infiltrated with saline to achieve a result, the result matched tissue sampling.

show abstract

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

Cited by 48 publications

References 30 publications

Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection

Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection

Optimal microbiological sampling for the diagnosis of osteoarticular infection

Hip aspiration culture: analysing data from a single operator series investigating periprosthetic joint infection

Contact Info

Product

Resources

About