Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe Seyler-Str. 3, 72076, Tübingen, Germany.
Department of Joint Replacement, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany.
Arch Orthop Trauma Surg. 2022 Nov;142(11):3157-3164. doi: 10.1007/s00402-021-03932-x. Epub 2021 May 15.
A common reason for painful shoulder arthroplasties and revision surgery is a low-grade periprosthetic joint infection (PJI). Diagnosing a low-grade infection is, however, a major diagnostic challenge. This applies even more to the shoulder, which differs from other large joints in terms of clinical features and microbiological spectrum. Aim of this study was to evaluate the diagnostic value of the synovial biopsy in the diagnostic workup of low-grade PJI of the shoulder.
A retrospective evaluation was conducted on 56 patients receiving revision surgery on their shoulder arthroplasty. A standardized preoperative workup was performed comprising CRP value, leukocyte blood count, synovial fluid microbiological analyses and leukocyte count from joint aspiration, and five synovial biopsy samples for bacteriologic and histologic analysis obtained through an arthroscopic approach. During revision surgery, five samples of periprosthetic tissue were harvested for bacteriologic and histologic analyses. The MSIS-Criteria 2014 were used to evaluate the diagnostic results.
In total, 15 of 56 revised prostheses turned out as PJI (27%). When applying our diagnostic workup, we obtained a sensitivity of 67% with a specificity of 95%. When performing a subgroup analysis on those patients that had received diagnostic biopsy, a sensitivity of 100% and a specificity of 83% could be achieved. With a sensitivity and specificity of 90% and 83%, respectively, the biopsy is the single method with the highest diagnostic value.
The sensitivity of only 67% of our standard workup emphasizes the difficulty to adequately diagnose low-grade infections after shoulder arthroplasty. The excellent specificity of 95% ensures, however, that non-infected prostheses are not incorrectly explanted. This study highlights that synovial biopsy has a high diagnostic value and should be done prior to complex revision surgeries to raise sensitivity in diagnosing a PJI.
肩部人工关节置换术后疼痛和翻修手术的常见原因是低度假体周围关节感染（PJI）。然而，诊断低度感染是一个主要的诊断挑战。这在肩部尤其如此，肩部在临床特征和微生物谱方面与其他大关节不同。本研究旨在评估关节滑膜活检在肩部低度 PJI 的诊断中的诊断价值。
对 56 例行肩部人工关节翻修术的患者进行了回顾性评估。进行了标准化的术前检查，包括 CRP 值、白细胞计数、关节滑液微生物分析和关节抽吸液白细胞计数，以及通过关节镜方法获得的 5 个滑膜活检样本进行细菌学和组织学分析。在翻修手术中，采集了 5 个假体周围组织样本进行细菌学和组织学分析。使用 2014 年 MSIS 标准评估诊断结果。
总共 56 个翻修假体中有 15 个（27%）被诊断为 PJI。应用我们的诊断方法，我们的敏感性为 67%，特异性为 95%。对接受诊断性活检的患者进行亚组分析时，可达到 100%的敏感性和 83%的特异性。活检的敏感性和特异性分别为 90%和 83%，是具有最高诊断价值的单一方法。
我们的标准检查的敏感性仅为 67%，强调了在肩部人工关节置换术后充分诊断低度感染的难度。然而，95%的优异特异性确保了未感染的假体不会被错误地取出。本研究强调了滑膜活检具有较高的诊断价值，应在复杂的翻修手术前进行，以提高诊断 PJI 的敏感性。
