开放性切开活检在疑似人工关节周围感染诊断中的微生物学优势

Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections.

作者信息

Niemann Marcel, Otto Ellen, Braun Karl F, Graef Frank, Ahmad Sufian S, Hardt Sebastian, Stöckle Ulrich, Trampuz Andrej, Meller Sebastian

机构信息

Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.

Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.

出版信息

J Clin Med. 2022 May 12;11(10):2730. doi: 10.3390/jcm11102730.

DOI:10.3390/jcm11102730

PMID:35628857

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9143629/

Abstract

BACKGROUND

Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification.

OBJECTIVE

This study investigates the potential benefit of OIB in THA and TKA patients with suspected PJI and ambigious diagnostic results following synovial fluid aspiration.

METHODS

We retrospectively assessed all patients treated from 2016 to 2020 with suspected PJI. Comparing the microbiology of OIB and the following revision surgery, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the number needed to treat (NNT).

RESULTS

We examined the diagnostic validity of OIB in 38 patients (20 female) with a median age of 66.5 years. In THA patients ( = 10), sensitivity was 75%, specificity was 66.67%, PPV was 60%, NPV was 80%, and NNT was 2.5. In TKA patients ( = 28), sensitivity was 62.5%, specificity was 95.24%, PPV was 83.33%, NPV was 86.96%, and NNT was 1.42.

CONCLUSIONS

Our results indicate that OIB represents an adequate diagnostic tool when previously assessed microbiological results remain inconclusive. Particularly in TKA patients, OIB showed an exceptionally high specificity, PPV, and NPV, whereas the predictive validity of the diagnosis of PJI in THA patients remained low.

摘要

背景

人工关节周围感染（PJI）是全髋关节置换术（THA）和全膝关节置换术（TKA）后一种严重的并发症。当术前滑液培养结果不明确时，开放性切开关节活检（OIB）有助于确定致病微生物。

目的

本研究探讨OIB在疑似PJI且滑液抽吸后诊断结果不明确的THA和TKA患者中的潜在益处。

方法

我们回顾性评估了2016年至2020年期间所有疑似PJI患者的治疗情况。通过比较OIB和后续翻修手术的微生物学结果，我们计算了敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和治疗所需人数（NNT）。

结果

我们检查了38例患者（20例女性）OIB的诊断有效性，患者中位年龄为66.5岁。在THA患者（n = 10）中，敏感性为75%，特异性为66.67%，PPV为60%，NPV为80%，NNT为2.5。在TKA患者（n = 28）中，敏感性为62.5%，特异性为95.24%，PPV为83.33%，NPV为86.96%，NNT为1.42。