Mirzaei Alireza, Shafiei Seyyed Hossein, Sadeghi-Naini Mohsen, Rikhtehgar Masih, Abolghasemian Mansour
Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, United States.
Front Surg. 2024 Aug 30;11:1410465. doi: 10.3389/fsurg.2024.1410465. eCollection 2024.
Aspiration represents the most potent method for exploring the potential occurrence of Periprosthetic Joint Infection (PJI). However, dry taps are common. While aspiration under ultrasound (US) guidance in the radiology department has become increasingly popular, hip aspiration is still routinely conducted in the operating room (OR) under x-ray guidance in numerous medical centers. When conducted within the confines of the OR, a dry tap aspiration not only subjects the patient to an unnecessary invasive procedure but also constitutes a substantial strain on OR time and resources. Our objective was to assess whether an outpatient US conducted before aspiration could reliably predict the likelihood of encountering a dry hip aspiration.
In a prospective study, we enrolled 50 hips who were suspected of PJI and slated for revision total hip arthroplasty and required hip aspiration. Before the aspiration procedure, we conducted an outpatient hip ultrasound (US) to assess the presence of fluid collection. Subsequently, all patients underwent aspiration under fluoroscopy in the OR, irrespective of the ultrasound findings We then assessed the level of agreement between the ultrasound results and the outcomes of hip aspiration.
The US exhibited a sensitivity of 95.7% (95% CI 69.8-91.8), a specificity of 74.1% (95% CI 52.8-91.8), a positive predictive value of 75.9% (95% CI 50.9-91.3), and a negative predictive value of 95.2% (95% CI 71.3-99.8) in predicting the success of aspiration.
Pre-aspiration outpatient US demonstrates a high degree of accuracy in predicting dry taps in these patients. We recommend its incorporation into the hip aspiration procedure in medical centers where aspiration is performed in the operating room. In the broader context, these findings reinforce the preference for US-guided aspiration within the radiology department over x-ray-guided aspiration in the operating room since about ¼ of the positive USs for hip collection will lead to a dry tap if the aspiration is performed in the OR under fluoroscopy guidance.
穿刺抽吸是探究假体周围关节感染（PJI）潜在发生情况的最有效方法。然而，抽不出液体的情况很常见。虽然在放射科超声（US）引导下进行穿刺抽吸越来越普遍，但在许多医疗中心，髋关节穿刺仍常规在手术室（OR）的X线引导下进行。在手术室范围内进行穿刺时，抽不出液体的穿刺不仅会让患者接受不必要的侵入性操作，还会给手术室的时间和资源带来巨大压力。我们的目的是评估在穿刺抽吸前进行门诊超声检查是否能可靠地预测髋关节穿刺抽不出液体的可能性。
在一项前瞻性研究中，我们纳入了50例怀疑患有PJI且计划进行翻修全髋关节置换术并需要进行髋关节穿刺抽吸的患者。在穿刺抽吸程序之前，我们进行了门诊髋关节超声（US）检查以评估是否存在积液。随后，无论超声检查结果如何，所有患者均在手术室的荧光透视引导下进行穿刺抽吸。然后，我们评估了超声检查结果与髋关节穿刺抽吸结果之间的一致性水平。
在预测穿刺抽吸成功方面，超声检查的敏感性为95.7%（95%置信区间69.8 - 91.8），特异性为74.1%（95%置信区间52.8 - 91.8），阳性预测值为75.9%（95%置信区间50.9 - 91.3），阴性预测值为95.2%（95%置信区间71.3 - 99.8）。
穿刺抽吸前的门诊超声检查在预测这些患者抽不出液体的情况方面显示出高度准确性。我们建议在手术室进行穿刺抽吸的医疗中心将其纳入髋关节穿刺抽吸程序。在更广泛的背景下，这些发现进一步支持了在放射科进行超声引导下穿刺抽吸优于在手术室进行X线引导下穿刺抽吸，因为如果在手术室荧光透视引导下进行穿刺，约四分之一超声检查显示髋关节有积液阳性的情况会抽不出液体。
