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

Meermans, Geert; Haddad, Fares S.

doi:10.1007/s11999-010-1245-4

Cited by 87 publications

(56 citation statements)

References 40 publications

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“…To this end, numerous researchers have focused on improving existing methods for diagnosing infection (ie, preoperative and intraoperative cultures [2,3,16,27,46] and Gram stain [2,12,20,49], serum markers of inflammation [19,23,27], synovial white blood cell [WBC] count and polymorphonuclear [PMN] percentages [5,21,29,34,48], intraoperative frozen section [11,14,15,17,42] and preoperative tissue biopsy [32,36], and nuclear medicine…”

Section: Introductionmentioning

confidence: 99%

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Parvızı

Jacovides

Adeli

et al. 2012

Clinical Orthopaedics &Amp; Related Research

100

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Background C-reactive protein (CRP) serum assays are a standard element of the diagnostic workup for periprosthetic joint infection (PJI). However, because CRP is a marker for systemic inflammation, this test is not specific to PJI. Questions/purposes Our purpose was to assess whether synovial fluid and serum assays alone could differentiate between infected and uninfected revision knee arthroplasties and to determine which of these methods had the greatest diagnostic accuracy. Methods We collected synovial fluid specimens from 66 patients undergoing revision total knee arthroplasty. Patients were judged uninfected or infected by standardized criteria. Synovial CRP levels were measured using an individual CRP assay (15 samples; 10 infected, five uninfected) and a multiplex immunoassay platform (59 samples; 25 infected, 34 uninfected). Results from preoperative standard serum CRP assays conducted were also collected (55 samples; 25 infected, 30 uninfected). Sensitivity, specificity, and receiver operating characteristic curve analyses were performed for each assay with a diagnosis of infection based on previously established criteria.Results Synovial CRP concentrations differed between infected and uninfected joints in the multiplex and serum analyses. The area under the curve was 0.84 for the individual assay, 0.91 for the multiplex assay, and 0.88 for the serum CRP assay. Sensitivity and specificity were 70.0% and 100.0% for the individual enzyme-linked immunosorbent assay, 84.0% and 97.1% for the multiplex assay, and 76.0% and 93.3% for the serum CRP assay. Conclusions An assay measuring CRP in synovial fluid may be more accurate in diagnosing PJI than the standard serum CRP assay. We believe such an assay holds promise as a new diagnostic marker for PJI.

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Section: Introductionmentioning

confidence: 99%

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Parvızı

Jacovides

Adeli

et al. 2012

Clinical Orthopaedics &Amp; Related Research

100

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“…In case of unexplained pain and/ or delayed wound healing, postoperative superficial infection, or persisting wound drainage, we obtained laboratory tests, radiographs, and a bone scan. When there was suspicion in the history for infection and C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) were increased or if there was a positive bone scan, a joint aspiration and biopsy were performed [25].…”

Section: Methodsmentioning

confidence: 99%

Is the Infection Rate in Primary THA Increased After Steroid Injection?

Meermans¹,

Corten²,

Simon³

2012

Clinical Orthopaedics &Amp; Related Research

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Background Injection of the hip is performed for diagnostic and therapeutic reasons. Articular cartilage deterioration and increased risk of prosthetic infection have been reported with steroid injections. However, the literature contains contradictory reports on an increased risk of infection after a subsequent THA. Questions/PurposesWe asked whether intraarticular steroid injection increased the rate of infection of a subsequent THA. Methods We retrospectively reviewed records of 175 patients in whom intraarticular steroid injections were given under strictly aseptic conditions using a lateral approach within 1 year before THA. These patients were matched with others from our database who had not received an injection for comorbidities, and for American Society of Anesthesiologists score, age, BMI, sex, type of implant, and year of THA.

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“…In a recent bibliographic search performed by Meermans et al [17], spanning the period from 1988 to 2010, 29 different studies were found regarding joint aspiration sensitivity in PJI, for both hip and knee cases. A summary of these studies showed a joint aspiration sensitivity of 71% on average.…”

Section: Discussionmentioning

confidence: 99%

“…Some authors have used synovial biopsy, obtained by various techniques, in an attempt to improve outcomes, but with inconsistent results [17][18][19].…”

Section: Discussionmentioning

confidence: 99%

Percutaneous interface biopsy in dry-aspiration cases of chronic periprosthetic joint infections: A technique for preoperative isolation of the infecting organism

Corona

Gil

Guerra

et al. 2011

International Orthopaedics (SICOT)

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Purpose Preoperative identification of the infecting microorganism is of paramount importance in the treatment protocol for chronic periprosthetic joint infections, as it enables selection of the most appropriate antibiotic treatment. Preoperative joint aspiration, the most commonly used sampling technique, has proven to have a broad range of sensitivity values and the frequency of dry aspirations has not been well assessed. In such dry-tap cases a biopsy sample could be an option. The purpose of this study was to assess the diagnostic accuracy of percutaneous interface biopsy (PIB) in isolating the infecting organism in cases of chronic Periprosthetic Joint Infection (PJI) and dry-tap event. The basic technique is to harvest and culture a sample from the periprosthetic interface membrane by a percutaneous technique in the preoperative period. Methods A retrospective study was done involving 24 consecutive patients suspected of PJI and where no fluid was obtained from the joint. Culture results from a percutaneous interface biopsy (PIB) were compared with intraoperative tissue cultures at the time of revision surgery. In all cases, a two-stage replacement was done. Results The sensitivity was 88.2%; specificity was 100%. Positive predictive value was 100%, while negative predictive value was 77.9%. Accuracy was 91.6%. No technique-related complication was observed. Conclusion We conclude that PIB is a useful test for preoperative isolation of the infecting organism and could play a role in cases with dry-tap joint aspirations.

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

Cited by 87 publications

References 40 publications

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Mark B. Coventry Award: Synovial C-reactive Protein: A Prospective Evaluation of a Molecular Marker for Periprosthetic Knee Joint Infection

Is the Infection Rate in Primary THA Increased After Steroid Injection?

Percutaneous interface biopsy in dry-aspiration cases of chronic periprosthetic joint infections: A technique for preoperative isolation of the infecting organism

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