Role of joint aspiration before re-implantation in patients with a cement spacer in place

Huguet, Sandra; Bernaus, Martí; Gómez, Lucía; Cuchí, Eva; Soriano, Álex; Font-Vizcarra, Lluís

doi:10.5312/wjo.v13.i6.615

Cited by 6 publications

(5 citation statements)

References 20 publications

(20 reference statements)

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“…S. Huguet с соавторами проанализировали эффективность дооперационной аспирации 20 ТБС. Согласно полученным результатам, чувствительность метода составила 0% [39].…”

Section: Discussionunclassified

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The impact of extended preoperative examination on the treatment tactics choice before the second stage of revision hip arthroplasty

Murylev,

Parvizi,

Rudnev

et al. 2024

Traumatology and Orthopedics of Russia

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Introduction. Performing diagnostic aspiration in patients with an established hip joint spacer as part of preoperative diagnosis is a controversial issue. Anyway, the rates of reinfection/recurrence of peri-implant infection during the 2nd stage of RHA remain quite high. The purpose of the study. To compare the diagnostic accuracy, specificity and sensitivity of the infection markers used within the framework of preoperative diagnostic protocols in order to exclude reinfection in patients with an established hip joint spacer before the second stage of RHA. To compare and analyze the microbiological landscape obtained at the stages of RHA. Material and methods. The evaluation of the diagnostic accuracy of the infection markers used was carried out in order to exclude reinfection/recurrence in 107 patients with an established hip joint spacer. The patients were divided into two groups: group 1 was prospective, an extended diagnostic protocol was used with performing diagnostic aspiration of synovial fluid and blood tests; group 2 was retrospective, a screening diagnostic protocol was used. The reference values of reinfection biomarkers used were based on the "small criteria" of the ICM 2018 protocol. According to the results of intraoperative microbiological examination of peri-implant tissue samples at the 1st and 2nd stages of RHA, the analysis of the obtained microflora was carried out in order to assess the likely recurrence/reinfection. Results. Reinfection among patients of both groups according to the results of intraoperative microbiological examination during the 2nd stage of RHA was diagnosed in 40% of cases: in 1 group of patients – 9 cases, in 2 group of patients – 31 cases. Synovial fluid during preoperative aspiration was obtained in 85% of cases, "dry joint" - in 15%. Conclusion. Performing preoperative diagnostic aspiration before the 2nd stage of RHA in patients with an installed spacer allowed in 9% of cases to choose the correct treatment strategy, demonstrating a diagnostic accuracy rate of 82.6%. The prevalent microflora in the structure of hip reinfection during the 2nd stage of RHA is represented by gram-positive coagulase-negative microorganisms.

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Section: Discussionunclassified

“…Примечательно, что в доступной литературе удалось найти не так много публикаций, в которых проводится анализ большого количества аспираций у пациентов с установленным спейсером ТБС [29,31,32,33,39].…”

Section: Discussionunclassified

The impact of extended preoperative examination on the treatment tactics choice before the second stage of revision hip arthroplasty

Murylev,

Parvizi,

Rudnev

et al. 2024

Traumatology and Orthopedics of Russia

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“…While this may have identified more positive cultures cases and deferred the second stage, the use of an aspiration with an antibiotic cement spacer in situ has been previously reported to be of limited value. 42 Furthermore, Cordero-Ampuero et al 43 have reported only 21% of culture-positive cases at reimplantation, translated into recurrence of infection defined by symptoms, radiological, and serological markers.…”

Section: Discussionmentioning

confidence: 99%

Change in organism between first- and second-stage revision for periprosthetic joint infection of knee arthroplasty independently associated with increased risk of failure

Walker,

Clement,

Yapp

et al. 2023

Bone Jt Open

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AimsAchievement of accurate microbiological diagnosis prior to revision is key to reducing the high rates of persistent infection after revision knee surgery. The effect of change in the microorganism between the first- and second-stage revision of total knee arthroplasty for periprosthetic joint infection (PJI) on the success of management is not clear.MethodsA two-centre retrospective cohort study was conducted to review the outcome of patients who have undergone two-stage revision for treatment of knee arthroplasty PJI, focusing specifically on isolated micro-organisms at both the first- and second-stage procedure. Patient demographics, medical, and orthopaedic history data, including postoperative outcomes and subsequent treatment, were obtained from the electronic records and medical notes.ResultsThe study cohort consisted of 84 patients, of whom 59.5% (n = 50) had successful eradication of their infection at a mean follow-up of 4.7 years. For the 34 patients who had recurrence of infection, 58.8% (n = 20) had a change in isolated organism, compared to 18% (n = 9) in the infection eradication group (p < 0.001). When adjusting for confound, there was no association when the growth on the second stage was the same as the first (odd ratio (OR) 2.50, 95% confidence interval (CI) 0.49 to 12.50; p = 0.269); however, when a different organism was identified at the second stage, this was independently associated with failure of treatment (OR 8.40, 95% CI 2.91 to 24.39; p < 0.001). There were no other significant differences between the two cohorts with regard to patient demographics or type of organisms isolated.ConclusionChange in the identified microorganism between first- and second-stage revision for PJI was associated with failure of management. Identification of this change in the microorganism prior to commencement of the second stage may help target antibiotic management and could improve the success of surgery in these patients.Cite this article: Bone Jt Open 2023;4(9):720–727.

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“…On the other hand, specificity was much higher, ranging from 85%–99%. However, false positives resulting in this setting remain a concern [ 12 , 29 – 35 ].…”

Section: Synovial Fluid Investigationmentioning

confidence: 99%

Interval between two-stage exchanges: what is optimal and how do you know?

et al. 2023

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Background Two-stage exchange arthroplasty remains the most popular option for the treatment of chronic periprosthetic joint infection (PJI). Determining infection eradication and optimal timing of reimplantation can be challenging. Information to allow for a truly informed evidence-based decision is scarce. Methods We conducted a critical review of available evidence on the presently available tests to help determine timing of reimplantation. Results Serology is traditionally used to follow up patients after the first stage. Despite tradition mandates waiting for normal inflammatory markers, there is actually no evidence that they correlate with persistent infection. The role of synovial fluid investigation between stages is also explored. Cultures lack sensitivity and neither differential leukocyte counts nor alternative biomarkers have proven to be accurate in identifying persistent infection with a spacer in situ. We also examined the evidence regarding the optimal time interval between resection and reimplantation and whether there is evidence to support the implementation of a two week “antibiotic holiday” prior to proceeding with reimplantation. Finally, wound healing and other important factors in this setting will be discussed. Conclusion Currently there are no accurate metrics to aid in the decision on the optimal timing for reimplantation. Decision must therefore rely on the resolution of clinical signs and down trending serological and synovial markers.

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Role of joint aspiration before re-implantation in patients with a cement spacer in place

Cited by 6 publications

References 20 publications

The impact of extended preoperative examination on the treatment tactics choice before the second stage of revision hip arthroplasty

The impact of extended preoperative examination on the treatment tactics choice before the second stage of revision hip arthroplasty

Change in organism between first- and second-stage revision for periprosthetic joint infection of knee arthroplasty independently associated with increased risk of failure

Interval between two-stage exchanges: what is optimal and how do you know?

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