Is Joint Aspiration to Rule Out Prosthetic Joint Infection Required Before every Revision Joint Arthroplasty? Validation of Institutional Criteria using the New European Bone and Joint Infection Society definition
Keywords:
Arthroplasty, Replacement, Hip, Prosthesis‐Related Infections, Synovial FluidAbstract
Introduction: Synovial fluid investigation is the best alternative to diagnose prosthetic joint infection (PJI) before ade‐ quate microbiological/histology sampling during revision surgery. Although accurate preoperative diagnosis is certainly recommended, puncturing every patient before revision arthroplasty raises concerns about safety and feasibility issues especially in difficult to access joint (e.g., hip). Currently, there is no clear guidelines regarding optimal indications to per‐ form preoperative joint aspiration to diagnose PJI before revision surgery. We hypothesize that our institutional criteria are appropriate to identify potentially infected joints before surgery while saving an unnecessary number of procedures. The main goal of this study is to determine the accuracy of our institutional criteria in picking up potentially infected joints using the new New European Bone and Joint Infection Society (EBJIS) PJI definition as the standard.Methods: We performed a retrospective review including all patients that underwent total hip or knee arthroplasty single or first‐stage revision surgery (regardless of preoperative diagnosis) between January 2013 and December 2019. We applied the new EBJIS PJI definition criteria and we studied patients whose institutional criteria were applied to perform preoperative joint aspiration.
Results: After applying the EBJIS definition 38 (35.8%) were classified as confirmed infections, 10 (9.4%) as likely infected and 58 (54.7%) as infection unlikely. Of those, 37 confirmed infection cases, 9 likely infected cases and 32 infection unlikely cases did have indication for preoperative synovial fluid collection before surgery.
Conclusion: Our proposed institutional criteria identify the majority of infected or likely infected patients, while saving a significant number of unlikely infected cases from unnecessary and potentially risky procedures.
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Copyright (c) 2024 Sara Elisa Diniz, André Vinha, Ana Ribau, Daniel Soares, Miguel Araújo Abreu, Ricardo Sousa (Author)
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