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

Sara Elisa Diniz; André Vinha; Ana Ribau; Daniel Soares; Miguel Araújo Abreu; Ricardo Sousa

Autores

Sara Elisa Diniz Centro Hospitala Universitário de Santo António Autor https://orcid.org/0000-0002-2386-5504
André Vinha Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal Autor
Ana Ribau Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal Autor
Daniel Soares Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal Autor
Miguel Araújo Abreu Department of Infectious Diseases, Centro Hospitalar Universitário de Santo António, Porto, Portugal Autor
Ricardo Sousa Orthopedics Department, Centro Hospitalar Universitário de Santo António, Porto, Portugal Autor

Palavras-chave:

Artroplastia da Anca, Infecções Relacionadas com a Prótese, Líquido Sinovial

Resumo

Introdução: A investigação do líquido sinovial é a melhor alternativa para diagnosticar a infeção da articulação protésica (IAP) antes da recolha de amostras microbiológicas/histológicas adequadas durante a cirurgia de revisão. Embora um diagnóstico pré‐operatório preciso seja certamente recomendado, a punção de todos os doentes antes da artroplastia de revisão suscita preocupações quanto a questões de segurança e viabilidade, especialmente em articulações de difícil acesso (por exemplo, anca). Atualmente, não existem diretrizes claras relativamente às indicações ideais para realizar a aspiração articular pré‐operatória para diagnosticar a IAP antes da cirurgia de revisão. A nossa hipótese é que os nossos critérios institucionais são adequados para identificar articulações potencialmente infetadas antes da cirurgia, poupando um número desnecessário de procedimentos. O principal objetivo deste estudo é determinar a precisão dos nossos critérios institucionais na identificação de articulações potencialmente infetadas, utilizando a nova definição de IAP da New European Bone and Joint Infection Society (EBJIS) como padrão.

Métodos: Realizámos uma revisão retrospetiva incluindo todos os doentes que foram submetidos a cirurgia de revisão de artroplastia total da anca ou do joelho simples ou de primeiro estágio (independentemente do diagnóstico pré‐operatório) entre janeiro de 2013 e dezembro de 2019. Aplicámos os novos critérios de definição de IAP da EBJIS e estudámos os doentes cujos critérios institucionais foram aplicados para realizar aspiração articular pré‐operatória.

Resultados: Após a aplicação da definição EBJIS, 38 (35,8%) foram classificados como infeções confirmadas, 10 (9,4%) como infeções prováveis e 58 (54,7%) como infeções improváveis. Destes, 37 casos de infeção confirmada, 9 casos de infeção provável e 32 casos de infeção improvável tinham indicação para recolha de líquido sinovial pré‐operatório antes da cirurgia.

Conclusão: Os critérios institucionais propostos identificam a maioria dos doentes infetados ou provavelmente infetados, poupando um número significativo de casos de infeção improvável a procedimentos desnecessários e potencialmente arriscados.

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