The Reliability of Diagnosis of Infection during Revision Arthroplasties

Abstract

It is clear from this study that no single test is able to show the presence of infection in every case. Classical clinical signs, laboratory tests, special imaging studies and joint aspirations have all yielded a notable rate of false negative results. Therefore, we recommend that, if arthroplasty patients have pain in prosthetic joint without clear radiological evidence of loosening, bone scans and preoperative joint aspirations should be undertaken. Also, if radiological evidence of loosening is accompanied with one or more of following criteria; C-reactive protein level elevated, radiologic evidence of infection, loosening within the first five years after implantation. In case of infection a delayed two-stage reconstruction should be managed.

Is There a Role for Tissue Biopsy in the Diagnosis of Periprosthetic Infection?

“…The serum level of CRP is regarded as an important diagnostic parameter and has a high sensitivity [59]. However, the specificity is generally lower, especially when patients with rheumatoid arthritis are included [20,25,65], and it does not identify the microorganism in question. Aspiration and biopsy offer the only chance of identifying the infective microorganism preoperatively [9,23,49,50].…”

Cost-effectiveness Analysis of Core Decompression

“…The decision model incorporates the need for subsequent hip revision surgery and the possible complications that can arise. The incidence of complications is assumed to increase with subsequent revision procedures, whereas the durability of revision arthroplasty is assumed to decrease relative to primary arthroplasty [24,26,27]. The probabilities of infection, dislocation, and mortality used in this model are shown in Table 1.…”

“…The rates of complications after THA have been reported by several authors [23][24][25][26][27][28][29]. The assumed durability of hip arthroplasty and incidence of complications including death, dislocation, and infection were selected to be in the midrange of accepted values.…”

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

“…Whereas early infections (occurring within the first 4 weeks after implantation) usually cause local and systemic inflammatory reactions, these responses do not always occur in patients with late infection [52]. This makes the diagnosis of late periprosthetic infections more difficult.…”