High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip
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High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip. / Fink, Bernd; Gebhard, Alexander; Fuerst, Martin; Berger, Irina; Schäfer, Peter.
in: CLIN ORTHOP RELAT R, Jahrgang 471, Nr. 3, 01.03.2013, S. 956-64.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip
AU - Fink, Bernd
AU - Gebhard, Alexander
AU - Fuerst, Martin
AU - Berger, Irina
AU - Schäfer, Peter
PY - 2013/3/1
Y1 - 2013/3/1
N2 - BACKGROUND: The role of the synovial biopsy in the preoperative diagnosis of a periprosthetic joint infection (PJI) of the hip has not been clearly defined.QUESTIONS/PURPOSES: We asked whether the value of a biopsy for a PJI is greater than that of aspiration and C-reactive protein (CRP).METHODS: Before revision in 100 hip endoprostheses, we obtained CRP values, aspirated the joint, and obtained five synovial biopsy samples for bacteriologic analysis and five for histologic analysis. Microbiologic and histologic analyses of the periprosthetic tissue during revision surgery were used to verify the results of the preoperative diagnostic methods. The minimum followup was 24 months (median 32; range, 24-47 months).RESULTS: Forty-five of the 100 prostheses were identified as infected. The biopsy, with a combination of the bacteriologic and histologic examinations, showed the greatest diagnostic value of all the diagnostic procedures and led to a sensitivity of 82% (95% CI, ± 11%), specificity of 98% (95% CI, ± 4%), positive predictive value of 97% (95% CI, ± 5%), negative predictive value of 87% (95% CI, ± 8.3%), and accuracy of 91%.CONCLUSIONS: The biopsy technique has a greater value than aspiration and CRP in the diagnosis of PJI of the hip (Masri et al. J Arthroplasty 22:72-78, 2007). In patients with a negative aspirate, but increased CRP or clinical signs of infection, we regard biopsy to be preferable to just repeating the aspiration.LEVEL OF EVIDENCE: Level II prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
AB - BACKGROUND: The role of the synovial biopsy in the preoperative diagnosis of a periprosthetic joint infection (PJI) of the hip has not been clearly defined.QUESTIONS/PURPOSES: We asked whether the value of a biopsy for a PJI is greater than that of aspiration and C-reactive protein (CRP).METHODS: Before revision in 100 hip endoprostheses, we obtained CRP values, aspirated the joint, and obtained five synovial biopsy samples for bacteriologic analysis and five for histologic analysis. Microbiologic and histologic analyses of the periprosthetic tissue during revision surgery were used to verify the results of the preoperative diagnostic methods. The minimum followup was 24 months (median 32; range, 24-47 months).RESULTS: Forty-five of the 100 prostheses were identified as infected. The biopsy, with a combination of the bacteriologic and histologic examinations, showed the greatest diagnostic value of all the diagnostic procedures and led to a sensitivity of 82% (95% CI, ± 11%), specificity of 98% (95% CI, ± 4%), positive predictive value of 97% (95% CI, ± 5%), negative predictive value of 87% (95% CI, ± 8.3%), and accuracy of 91%.CONCLUSIONS: The biopsy technique has a greater value than aspiration and CRP in the diagnosis of PJI of the hip (Masri et al. J Arthroplasty 22:72-78, 2007). In patients with a negative aspirate, but increased CRP or clinical signs of infection, we regard biopsy to be preferable to just repeating the aspiration.LEVEL OF EVIDENCE: Level II prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Arthroplasty, Replacement, Hip
KW - Bacteriological Techniques
KW - Biological Markers
KW - Biopsy
KW - Biopsy, Needle
KW - C-Reactive Protein
KW - Female
KW - Hip Joint
KW - Hip Prosthesis
KW - Humans
KW - Male
KW - Middle Aged
KW - Predictive Value of Tests
KW - Prospective Studies
KW - Prosthesis-Related Infections
KW - Reoperation
KW - Sensitivity and Specificity
KW - Synovial Membrane
U2 - 10.1007/s11999-012-2474-5
DO - 10.1007/s11999-012-2474-5
M3 - SCORING: Journal article
C2 - 22806261
VL - 471
SP - 956
EP - 964
JO - CLIN ORTHOP RELAT R
JF - CLIN ORTHOP RELAT R
SN - 0009-921X
IS - 3
ER -