Treu Emily A, Cushman Daniel M, Wheelwright John C, Blackburn Brenna E, Teramoto Masaru, Archibeck Michael J
Department of Orthopedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
Department of Physical Medicine & Rehabilitation, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
J Bone Jt Infect. 2023 May 9;8(3):151-163. doi: 10.5194/jbji-8-151-2023. eCollection 2023.
: aspiration of total hip arthroplasty (THA) is commonly performed to assist in the diagnosis of prosthetic joint infection (PJI). This study aimed to determine whether fluoroscopic- or ultrasound- guided hip aspiration differs in the ability to acquire synovial fluid and in the accuracy of diagnosing infection. all THA aspirations performed between 2014 and 2021 at our institution were retrospectively identified. Aspirations were classified as successful or dry. If successful, the volume of fluid obtained was recorded. The sensitivity and specificity of hip aspiration in identifying PJI were calculated with four methods: (1) culture results excluding saline lavage, (2) culture results including saline lavage, (3) 2018 Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) criteria, and (4) 2021 European Bone and Joint Infection Society (EBJIS) criteria. Analyses were performed using Student's test or Wilcoxon rank sum for continuous variables and chi-squared or Fisher's exact test for categorical variables. 290 aspirations were included (155 fluoroscopic-guided and 135 ultrasound-guided). Success of aspiration ( mL) was more common in the ultrasound cohort (69 %) than fluoroscopy (53 %) (). When successful, more volume was obtained in the ultrasound cohort (mean 13.1 mL vs. 10.0 mL; ). Ultrasound-guided aspiration was more sensitive than fluoroscopy in diagnosing PJI using culture results excluding saline lavage (85 % vs. 73 %; ), culture results including saline lavage (85 % vs. 69 %; ), 2018 MSIS-ICM criteria (77 % vs. 52 %; ), and 2021 EBJIS criteria (87 % vs. 65 %; ). Ultrasound-guided aspiration was more specific than fluoroscopy in diagnosing PJI using 2021 EBJIS criteria (100 % vs. 96 %; ). ultrasound-guided aspiration is more frequently successful and yields more fluid than fluoroscopic-guided aspiration of THA. Ultrasound-guided aspiration is more sensitive in diagnosing PJI than fluoroscopy using culture data, 2018 MSIS-ICM criteria, and 2021 EBJIS criteria.
全髋关节置换术（THA）抽吸术常用于辅助诊断人工关节感染（PJI）。本研究旨在确定透视引导或超声引导下的髋关节抽吸术在获取滑液的能力以及诊断感染的准确性方面是否存在差异。回顾性确定了2014年至2021年在本机构进行的所有THA抽吸术。抽吸术分为成功或无液体获取。若成功，记录获取的液体量。采用四种方法计算髋关节抽吸术诊断PJI的敏感性和特异性：（1）排除盐水灌洗的培养结果，（2）包括盐水灌洗的培养结果，（3）2018年肌肉骨骼感染学会（MSIS）国际共识会议（ICM）标准，以及（4）2021年欧洲骨与关节感染学会（EBJIS）标准。对连续变量使用Student检验或Wilcoxon秩和检验，对分类变量使用卡方检验或Fisher精确检验进行分析。纳入了290例抽吸术（155例透视引导和135例超声引导）。超声引导组抽吸成功（毫升）的情况比透视引导组更常见（69%对53%）（）。抽吸成功时，超声引导组获取的液体量更多（平均13.1毫升对10.0毫升；）。在使用排除盐水灌洗的培养结果（85%对73%；）、包括盐水灌洗的培养结果（85%对69%；）、2018年MSIS-ICM标准（77%对52%；）以及2021年EBJIS标准（87%对65%；）诊断PJI时，超声引导下的抽吸术比透视引导下的更敏感。在使用2021年EBJIS标准诊断PJI时，超声引导下的抽吸术比透视引导下的更具特异性（100%对96%；）。与THA的透视引导抽吸术相比，超声引导抽吸术更常成功且获取的液体更多。使用培养数据、2018年MSIS-ICM标准和2021年EBJIS标准时，超声引导抽吸术在诊断PJI方面比透视引导更敏感。
