The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty
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The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty. / Fink, Bernd; Schuster, Philipp; Braun, Rüdiger; Tagtalianidou, Eli; Schlumberger, Michael.
In: BONE JOINT J, Vol. 102-B, No. 3, 03.2020, p. 329-335.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty
AU - Fink, Bernd
AU - Schuster, Philipp
AU - Braun, Rüdiger
AU - Tagtalianidou, Eli
AU - Schlumberger, Michael
PY - 2020/3
Y1 - 2020/3
N2 - AIMS: Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence.METHODS: A total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS).RESULTS: In total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive value (PPV) of 94.9%, a negative predictive value (NPV) of 96.7%, and an accuracy of 96.1%. Of the 178 infected patients, 26 showed a difference in the detected bacteria from the biopsy and the revision surgery (14.6%). This difference required a change to antibiotic therapy in only two cases (1.1%).CONCLUSION: Biopsy is a useful tool to diagnose PJI, but there may be a difference in the detected bacteria between the biopsy and revision surgery. However, this did not affect the choice of antibiotic therapy in most cases, rendering the clinical relevance of this phenomenon as low. Cite this article: Bone Joint J 2020;102-B(3):329-335.
AB - AIMS: Biopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence.METHODS: A total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS).RESULTS: In total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive value (PPV) of 94.9%, a negative predictive value (NPV) of 96.7%, and an accuracy of 96.1%. Of the 178 infected patients, 26 showed a difference in the detected bacteria from the biopsy and the revision surgery (14.6%). This difference required a change to antibiotic therapy in only two cases (1.1%).CONCLUSION: Biopsy is a useful tool to diagnose PJI, but there may be a difference in the detected bacteria between the biopsy and revision surgery. However, this did not affect the choice of antibiotic therapy in most cases, rendering the clinical relevance of this phenomenon as low. Cite this article: Bone Joint J 2020;102-B(3):329-335.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Arthroplasty, Replacement, Hip/adverse effects
KW - Arthroplasty, Replacement, Knee/adverse effects
KW - Bacteria/isolation & purification
KW - Biopsy/methods
KW - Delayed Diagnosis
KW - Female
KW - Follow-Up Studies
KW - Hip Joint/microbiology
KW - Hip Prosthesis/adverse effects
KW - Humans
KW - Knee Joint/microbiology
KW - Knee Prosthesis/adverse effects
KW - Male
KW - Middle Aged
KW - Prospective Studies
KW - Prosthesis-Related Infections/diagnosis
KW - Reproducibility of Results
U2 - 10.1302/0301-620X.102B3.BJJ-2019-0684.R1
DO - 10.1302/0301-620X.102B3.BJJ-2019-0684.R1
M3 - SCORING: Journal article
C2 - 32114807
VL - 102-B
SP - 329
EP - 335
JO - BONE JOINT J
JF - BONE JOINT J
SN - 2049-4394
IS - 3
ER -
