Department of Radiology and Biomedical Imaging, University of California, San Francisco, 185 Berry St, Suite 350, San Francisco, CA, 94158, USA.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Skeletal Radiol. 2021 Nov;50(11):2245-2254. doi: 10.1007/s00256-021-03795-8. Epub 2021 May 6.
To assess the value of preoperative joint aspiration in detecting periprosthetic joint infection (PJI) in patients undergoing revision hip arthroplasty and to compare these with the clinical findings, serum markers, and intraoperative findings.
Fluoroscopically guided hip aspirations in patients with pain after hip arthroplasty were retrospectively reviewed from January 2014 to December 2018. All hips underwent subsequent revision hip arthroplasty. Antibiotics were discontinued at least 2 weeks before the aspiration. The 2018 Musculoskeletal Infection Society (MSIS) criteria served as a standard of reference for PJI. Clinical, serum, synovial, and intraoperative parameters were recorded in all patients. Correlations between all parameters with PJI diagnosis were analyzed using linear and logistic regression models with ROC analysis.
In 202 hips that included 91 septic hips, hip aspiration (AUC = 0.78) and intraoperative (0.80) parameters performed better than serum-based tests (0.64) and clinical parameters (0.68) in detecting PJI. Using MSIS criteria as a standard of reference, hip aspiration had a sensitivity of 64.0% and an accuracy of 78.5% for cultures and a sensitivity of 74.2% and an accuracy of 82.1% for synovial polymorphonuclear neutrophils% (PMN%). Results substantially improved sensitivity after excluding patients that were treated with antibiotics, particularly culture results.
Preoperative hip aspiration showed good diagnostic performance in diagnosing PJI compared with MSIS criteria as a standard of reference. But a negative result from aspirate could not rule out PJI. Based on our findings, hip aspiration is an essential test for treatment planning in patients with pain after hip arthroplasty.
评估术前关节抽吸术在检测接受髋关节翻修术患者的假体周围关节感染（PJI）中的价值，并将其与临床发现、血清标志物和术中发现进行比较。
回顾性分析了 2014 年 1 月至 2018 年 12 月间因髋关节置换术后疼痛而行髋关节透视引导下关节抽吸术的患者。所有髋关节均接受了后续的髋关节翻修术。在抽吸前至少停用抗生素 2 周。2018 年肌肉骨骼感染协会（MSIS）标准作为 PJI 的参考标准。所有患者均记录了临床、血清、滑膜和术中参数。使用 ROC 分析，线性和逻辑回归模型分析了所有参数与 PJI 诊断之间的相关性。
在 202 例髋关节中，包括 91 例感染性髋关节，髋关节抽吸术（AUC=0.78）和术中参数（0.80）在检测 PJI 方面优于基于血清的检测（0.64）和临床参数（0.68）。使用 MSIS 标准作为参考标准，髋关节抽吸术在培养物方面的敏感性为 64.0%，准确性为 78.5%，在滑膜多形核中性粒细胞%（PMN%）方面的敏感性为 74.2%，准确性为 82.1%。排除接受抗生素治疗的患者后，结果显著提高了敏感性，尤其是培养物结果。
与 MSIS 标准作为参考标准相比，术前髋关节抽吸术在诊断 PJI 方面具有良好的诊断性能。但是，抽吸物的阴性结果不能排除 PJI。根据我们的发现，髋关节抽吸术是髋关节置换术后疼痛患者治疗计划的重要检查。
