High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip

Bernd Fink; Alexander Gebhard; Martin Fuerst; Irina Berger; Peter Schäfer

doi:10.1007/s11999-012-2474-5

High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip

Standard

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, Vol. 471, No. 3, 01.03.2013, p. 956-64.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Fink, B, Gebhard, A, Fuerst, M, Berger, I & Schäfer, P 2013, 'High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip', CLIN ORTHOP RELAT R, vol. 471, no. 3, pp. 956-64. https://doi.org/10.1007/s11999-012-2474-5

APA

Fink, B., Gebhard, A., Fuerst, M., Berger, I., & Schäfer, P. (2013). High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip. CLIN ORTHOP RELAT R, 471(3), 956-64. https://doi.org/10.1007/s11999-012-2474-5

Vancouver

Fink B, Gebhard A, Fuerst M, Berger I, Schäfer P. High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip. CLIN ORTHOP RELAT R. 2013 Mar 1;471(3):956-64. https://doi.org/10.1007/s11999-012-2474-5

Bibtex

@article{0e92f460ecd04072ad97e061d518d3f6,

title = "High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip",

abstract = "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.",

keywords = "Adult, Aged, Aged, 80 and over, Arthroplasty, Replacement, Hip, Bacteriological Techniques, Biological Markers, Biopsy, Biopsy, Needle, C-Reactive Protein, Female, Hip Joint, Hip Prosthesis, Humans, Male, Middle Aged, Predictive Value of Tests, Prospective Studies, Prosthesis-Related Infections, Reoperation, Sensitivity and Specificity, Synovial Membrane",

author = "Bernd Fink and Alexander Gebhard and Martin Fuerst and Irina Berger and Peter Sch{\"a}fer",

year = "2013",

month = mar,

day = "1",

doi = "10.1007/s11999-012-2474-5",

language = "English",

volume = "471",

pages = "956--64",

journal = "CLIN ORTHOP RELAT R",

issn = "0009-921X",

publisher = "Springer New York",

number = "3",

}

RIS

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 -