Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty

Cross, M.; Kransdorf, Mark J.; Chivers, F. Spencer; Lorans, Roxanne; Roberts, Catherine C.; Schwartz, Adam J.; Beauchamp, C.P.

doi:10.1007/s00256-013-1757-6

Cited by 30 publications

(37 citation statements)

References 12 publications

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“…In contrast to our results, Cross et al report an inferior sensitivity of 41% of synovial biopsy utilizing a fine-needle biopsy technique and local anesthesia compared to sole percutaneous joint aspiration for diagnosing PJI in a retrospective study of 110 THAs [9]. Likewise, Williams and colleagues could not identify beneficial results for tissue biopsy and sole bacteriological examination [17].…”

Section: Discussioncontrasting

confidence: 99%

Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip

et al. 2017

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BackgroundDiagnosis of a low-grade periprosthetic joint infection (PJI) prior to revision surgery can be challenging, despite paramount importance for further treatment. Arthroscopic biopsy of synovial and periprosthetic tissue with subsequent microbiological and histological examination can be beneficial but its specific diagnostic value has not been clearly defined.Methods20 consecutive patients who underwent percutaneous synovial fluid aspiration as well as arthroscopic biopsy due to suspected PJI of the hip and subsequent one- or two-stage revision surgery at our institution between January 2012 and May 2015 were enrolled. Indication was based on the criteria (1) history of PJI and increased levels of erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP), (2) suspicious cell count and differential but negative bacterial culture in synovial aspirate, (3) early loosening (

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Section: Discussioncontrasting

confidence: 99%

Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip

et al. 2017

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“…NOTE: Ship the sample to the microbiology lab without delay for PCR analysis. From the same sample, conventional microbiological aerobic and anaerobic cultures can also be set up 17 . Transfer 1 to 4 mL of the joint aspirate into a blood collection tube containing EDTA for cell count and differentiation 2 .…”

Section: Protocolmentioning

confidence: 99%

“…NOTE: Ship the sample to the microbiology lab without delay for PCR analysis. From the same sample, conventional microbiological aerobic and anaerobic cultures can also be set up 17 .…”

Section: Protocolmentioning

confidence: 99%

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

Hischebeth

Gravius

Buhr

et al. 2017

JoVE

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In orthopedic patients, foreign body-associated infections, especially periprosthetic joint infections (PJIs), are a devastating complication of arthroplasty. Infection requires complex treatment, may result in long hospitalization and causes considerable costs. Multiple surgical revisions can be necessary in these patients, with a loss in function as well as in quality of life.The routine preoperative diagnostics include blood examination for C-reactive protein (CRP) and other biomarkers, as well as joint aspirate analysis for cell count, differentiation, and culture. Intraoperative specimens for histology and microbiology are also standard procedure. The microbiological examination of removed implants with sonication, in combination with the implementation of molecular biology techniques in microbiology, represent two novel techniques currently employed to enhance the differential diagnostics of PJI.We present here the step-wise procedure of analyzing joint aspirate and sonication fluid, using a cartridge-based multiplex polymerase chain reaction (PCR) system. Results were matched against conventional cultures and consensus criteria for PJI. Conventional microbiological cultures from tissue biopsies, joint aspirate and sonication fluid showed a sensitivity of 66.7%, 66.7%, and 88.9%, respectively, and a specificity of 82.3%, 54.6%, and 61.5%, respectively. The PCR diagnostic of the sonication fluid and the joint fluid showed a sensitivity of 50.0% and 55.6%, respectively, and both a specificity of 100.0%. Both PCR diagnostics combined had a sensitivity of 66.7% and a specificity of 100.0%. The multiplex PCR therefore presents a rapid diagnostic tool with moderate sensitivity but high specificity in diagnosing PJI.

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“…169,170 In addition, synovial biopsy can be effective in diagnosing periprosthetic infections prior to revision arthroplasty, 171 but is not superior to synovial fluid aspiration for microbial culture. 172…”

Section: Synoviummentioning

confidence: 99%

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

Pritzker

Nieminen

2019

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Needle biopsy of diseased tissue is an essential diagnostic tool that is becoming even more important as precision medicine develops. However, the capability of this modality to efficiently provide samples adequate for diagnostic and prognostic analysis remains quite limited relative to current diagnostic needs. For physicians and patients, inadequate biopsy frequently leads to diagnostic delay, procedure duplication, or insufficient information about tumor biology leading to delay in treatment; for health systems, this results in substantial incremental costs and inefficient use of scarce specialized diagnostic resources. Objective.— To review current needle biopsy technology, devices, and practice with a perspective to identify current limitations and opportunities for improvement in the context of advancing precision medicine. Data Sources.— PubMed searches of fine-needle aspiration and core needle biopsy devices and similar technologies were made generally, by tissue site, and by adequacy as well as by health economics of these technologies. Conclusions.— Needle biopsy adequacy can be improved by recognizing the importance of this diagnostic tool by promoting common criteria for needle biopsy adequacy; by optimizing needle biopsy procedural technique, technologies, clinical practice, professional education, and quality assurance; and by bundling biopsy procedure costs with downstream diagnostic modalities to provide better accountability and incentives to improve the diagnostic process.

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Utility of percutaneous joint aspiration and synovial biopsy in identifying culture-positive infected hip arthroplasty

Abstract: Standard microbiological analyses performed on percutaneous synovial biopsy specimen during the preoperative evaluation of patients undergoing revision hip arthroplasty did not improve detection of culture-positive periprosthetic infection as compared to synovial fluid aspiration alone.

Cited by 30 publications

References 12 publications

Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip

Diagnostic accuracy of arthroscopic biopsy in periprosthetic infections of the hip

Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction

Needle Biopsy Adequacy in the Era of Precision Medicine and Value-Based Health Care

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