Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

Abstract

Background: Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification. Objective: This study investigates the potential benefit of OIB in THA and TKA patients with suspected PJI and ambigious diagnostic results following synovial fluid aspiration. Methods: We retrospectively assessed all patients treated from 2016 to 2020 with suspected PJI. Comparing the microbiology of OIB and the following revision surgery, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the number needed to treat (NNT). Results: We examined the diagnostic validity of OIB in 38 patients (20 female) with a median age of 66.5 years. In THA patients (n = 10), sensitivity was 75%, specificity was 66.67%, PPV was 60%, NPV was 80%, and NNT was 2.5. In TKA patients (n = 28), sensitivity was 62.5%, specificity was 95.24%, PPV was 83.33%, NPV was 86.96%, and NNT was 1.42. Conclusions: Our results indicate that OIB represents an adequate diagnostic tool when previously assessed microbiological results remain inconclusive. Particularly in TKA patients, OIB showed an exceptionally high specificity, PPV, and NPV, whereas the predictive validity of the diagnosis of PJI in THA patients remained low.

Low accuracy in preoperative tissue biopsies for diagnosing chronic periprosthetic joint infection: an observational retrospective single-centre study

“…33 As an additional limitation, at our hospital, the standard procedure is to incubate cultures for 14 days, as in several other hospitals. 9,24,29 Incubation periods for lowvirulence organisms can require additional time and may result in negative cultures if evaluated too soon. 34 The 14-day incubation period might have contributed to lowering the detection rate of low-virulence bacteria because these bacteria may require up to 21 days of incubation for detection.…”

“…24 A recent study by Niemann et al of 38 patients with PJI after THA and TKA reported a sensitivity of 67% and specificity of 89%. 29 These studies compared the results of intraoperative biopsies with those of preoperative biopsies when calculating accuracy. 24 A study by Klaber et al of 126 patients with PJI after THA and TKA used the ICM 2013 criteria as a reference and obtained open biopsies.…”

“…of 38 patients with PJI after THA and TKA reported a sensitivity of 67% and specificity of 89%. 29 These studies compared the results of intraoperative biopsies with those of preoperative biopsies when calculating accuracy. 24 A study by Klaber et al.…”