The accuracy of joint aspiration for the diagnosis of shoulder infections

Hecker, Andreas; Jungwirth-Weinberger, Anna; Bauer, Michael R.; Tondelli, Timo; Uçkay, İlker; Wieser, Karl

doi:10.1016/j.jse.2019.07.016

Cited by 29 publications

(22 citation statements)

References 20 publications

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“…Moreover, especially in low-grade infections of the shoulder very little or no aspirate can be obtained. Punctio sicca occurred in 48% in our collective, which is comparable with other studies [14]. In primary cases of punctio sicca, irrigation with saline solution seems not to be promising [14].…”

Section: Discussionsupporting

confidence: 88%

“…Punctio sicca occurred in 48% in our collective, which is comparable with other studies [14]. In primary cases of punctio sicca, irrigation with saline solution seems not to be promising [14]. Further synovial fluid analyses are, therefore, often not possible.…”

Section: Discussionsupporting

confidence: 82%

“…Other studies investigating the sensitivity of microbiological examination of joint aspirate present a highly heterogeneous picture ranging in sensitivity from 7 to 81%. These sensitivities need to be seen in the context of the specific joint examined and the present microbiological spectrum [6,14,15]. Overall, however, the diagnostic value of aspiration must be classified as low.…”

Section: Discussionmentioning

confidence: 99%

“…S. epidermidis, S. capitis, S. haemolyticus) [24,26,27]. In addition, standard diagnostic measures such as joint aspiration are often inconclusive, and in many cases-in contrast to other joints like the knee or hip-not possible due to punctio sicca [14].…”

Section: Introductionmentioning

confidence: 99%

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The significance of synovial biopsy in the diagnostic workup of the low-grade periprosthetic joint infection of shoulder arthroplasty

Mederake

Hofmann

Fink

2021

Arch Orthop Trauma Surg

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Introduction A common reason for painful shoulder arthroplasties and revision surgery is a low-grade periprosthetic joint infection (PJI). Diagnosing a low-grade infection is, however, a major diagnostic challenge. This applies even more to the shoulder, which differs from other large joints in terms of clinical features and microbiological spectrum. Aim of this study was to evaluate the diagnostic value of the synovial biopsy in the diagnostic workup of low-grade PJI of the shoulder. Materials and methods A retrospective evaluation was conducted on 56 patients receiving revision surgery on their shoulder arthroplasty. A standardized preoperative workup was performed comprising CRP value, leukocyte blood count, synovial fluid microbiological analyses and leukocyte count from joint aspiration, and five synovial biopsy samples for bacteriologic and histologic analysis obtained through an arthroscopic approach. During revision surgery, five samples of periprosthetic tissue were harvested for bacteriologic and histologic analyses. The MSIS-Criteria 2014 were used to evaluate the diagnostic results. Results In total, 15 of 56 revised prostheses turned out as PJI (27%). When applying our diagnostic workup, we obtained a sensitivity of 67% with a specificity of 95%. When performing a subgroup analysis on those patients that had received diagnostic biopsy, a sensitivity of 100% and a specificity of 83% could be achieved. With a sensitivity and specificity of 90% and 83%, respectively, the biopsy is the single method with the highest diagnostic value. Conclusions The sensitivity of only 67% of our standard workup emphasizes the difficulty to adequately diagnose low-grade infections after shoulder arthroplasty. The excellent specificity of 95% ensures, however, that non-infected prostheses are not incorrectly explanted. This study highlights that synovial biopsy has a high diagnostic value and should be done prior to complex revision surgeries to raise sensitivity in diagnosing a PJI.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

The significance of synovial biopsy in the diagnostic workup of the low-grade periprosthetic joint infection of shoulder arthroplasty

Mederake

Hofmann

Fink

2021

Arch Orthop Trauma Surg

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“…All prior septic arthritis had been treated by various numbers of lavages and prolonged antibiotic administration for different causative microorganisms (Table I). The persistence of infection was ruled out before RTSA implantation by the absence of fever, night sweats, local redness or heat, normal serum C-reactive protein values (<10 mg/L) and white blood cell count (>2 G/L and <10 G/L), a negative joint aspiration, 12 and finally by negative intraoperative microbiological assessments in several samples.…”

Section: General Resultsmentioning

confidence: 99%

Limited improvement and high rate of complication in patients undergoing reverse total shoulder arthroplasty for previous native shoulder infection

Kriechling

Bouaicha

Andronic

et al. 2021

Journal of Shoulder and Elbow Surgery

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Background: The outcomes of reverse total shoulder arthroplasty (RTSA) surgery for the sequelae of former septic native joint shoulder arthritis are unknown but might be inferior to patients without prior bacterial arthritis. Methods: We performed a single-center case-control study embedded in our prospective RTSA cohort. We matched all patients with prior infections in a 1:1 ratio with patients who underwent RTSA for other indications. The matching variables were indication for surgery, age, sex, dominant/nondominant shoulder, and body mass index. We evaluated outcomes by Constant score and active function. Results: Among 1249 patients in the RTSA cohort, 14 were operated for sequelae of previous native shoulder joint infections. Although both groups significantly improved from preoperative to postoperative values, the outcome of postinfectious patients was clearly inferior in comparison with the control group (absolute [38 AE 17 vs. 75 AE 8, P < .01], relative Constant score [47 AE 19 vs. 88 AE 9, P < .01], Constant pain score [11.0 AE 3.1 vs. 14.3 AE 1.3, P < .01], subjective shoulder value [43 AE 26 vs. 85 AE 10, P < .01], abduction [70 AE 43 vs. 148 AE 29 , P ¼ .001], and elevation [82 AE 49 to 131 AE 16 , P ¼ .02]). Moreover, in the postinfectious group, overall surgical complications occurred in 36%, with the need for revision in 21%. There was, however, no recurrence of infection in any of the patients' shoulders. Conclusion: RTSA for end-stage postinfectious joint disease is associated with a high number of complications and reoperations. Clinical outcomes are inferior to those without past infection.

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