Gould E S, Potter H G, Bober S E
Department of Radiology, North Shore University Hospital/Cornell University Medical College, Manhasset, NY 11030.
Skeletal Radiol. 1990;19(6):427-30. doi: 10.1007/BF00241797.
We undertook a retrospective review of 78 percutaneous hip aspirations performed as a prerequisite to prosthetic revision or replacement. Although the majority of the patients were already scheduled for revision or replacement, many aspirations were requested as part of the "routine" algorithm in the evaluation of a painful hip. Cultures from the aspirated fluid were compared with those obtained intraoperatively (where possible) and to the clinical suspicion of infection. Many of the selected patients had clinical and/or radiographic indications of pain. Our results yielded no evidence of infection (0%) when there was no clinical suspicion of infection (60 patients). Clinical suspicion for infection was high in 7 patients; aspirates demonstrated infection in 5 of them. One aspiration was false negative for infection, but subsequent intraoperative cultures were positive. When the clinical suspicion was intermediate or equivocal (11 patients), results were negative in 9 and positive in 2, both at aspiration and intraoperatively. We contend that routine percutaneous hip aspirations do not need to be performed when a prosthetic revision or replacement is contemplated if the clinical suspicion for infection is low. Hip aspiration and arthrography should not be eliminated, however, when the clinical suspicion is equivocal or high or when there is no apparent cause for a painful prosthesis.
我们对78例经皮髋关节穿刺抽吸术进行了回顾性研究，这些抽吸术是假体翻修或置换的前提条件。尽管大多数患者已安排进行翻修或置换，但许多抽吸术是作为评估疼痛性髋关节的“常规”流程的一部分而要求进行的。将抽吸液的培养结果与术中（如有可能）获得的结果以及临床感染怀疑情况进行了比较。许多入选患者有疼痛的临床和/或影像学指征。当没有临床感染怀疑时（60例患者），我们的结果未发现感染证据（0%）。7例患者临床感染怀疑度高；其中5例抽吸物显示有感染。1例抽吸物感染检测为假阴性，但随后的术中培养结果为阳性。当临床怀疑为中度或不明确时（11例患者），抽吸及术中结果9例为阴性，2例为阳性。我们认为，如果临床感染怀疑度低，在考虑假体翻修或置换时无需进行常规经皮髋关节穿刺抽吸术。然而，当临床怀疑不明确或高度怀疑时，或当假体疼痛无明显原因时，不应取消髋关节穿刺抽吸术和关节造影。
