Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture
- PMID: 8642032
- DOI: 10.2106/00004623-199605000-00015
Aspiration of the hip joint before revision total hip arthroplasty. Clinical and laboratory factors influencing attainment of a positive culture
Abstract
The value of routine aspiration of the hip joint before revision of a hip arthroplasty remains controversial. We reviewed the results of such aspirations in an attempt to determine clinical or laboratory factors that could help the surgeon to identify hips that are infected and that should be aspirated preoperatively. One hundred and fifty consecutive revision total hip arthroplasties were performed by one of us. Preoperative aspiration was not performed or data were excluded for eight hips; no fluid was obtained from one of these hips (0.7 percent of the 150). Of the remaining 142 hips, 128 had preoperative aspiration once and fourteen, twice. Twenty-one (15 percent) of the 142 hips were infected, as demonstrated by the intraoperative culture. The intraoperative culture for two of these hips, however, was considered to be false-positive. The initial aspiration was considered to be positive only if an organism grew on the solid medium or if grossly purulent fluid was obtained. The initial aspiration was positive for nineteen hips; on culture of specimens from one hip, Bacteroides thetaiotaomicron grew in the liquid medium only; and purulent fluid was obtained from one hip but no organisms grew on culture. Fourteen aspirations were repeated for various reasons, most commonly to confirm the presence of an unusual organism. The repeat aspiration did not change the diagnosis for these hips. When the two hips with a false-positive intraoperative culture were excluded, preoperative aspiration had a sensitivity of 92 percent, a specificity of 97 percent, and an accuracy of 96 percent. Seventeen of the nineteen truly infected hips were associated with an abnormally elevated erythrocyte-sedimentation rate (mean, 80.8 millimeters per hour). However, fifty-eight (50 percent) of the 116 hips that were not infected, and for which the results were available, also had an abnormally elevated erythrocyte-sedimentation rate (mean, 32.0 millimeters per hour). This difference was significant (p = 0.001, Fischer exact test). The peripheral leukocyte count was not helpful in predicting infection. Hips in which the implants had been in situ for more than five years were less likely to be infected (p = 0.008, Fisher exact test) than those in which the implants had been in situ for five years or less. None of the infected hips in which the implants had been in situ for more than five years were associated with a normal erythrocyte-sedimentation rate. In this study, preoperative aspiration of the hip joint had an excellent sensitivity and specificity with regard to the prediction of infection, On the basis of our findings, we now favor a selective approach to aspiration, as determined by the erythrocyte sedimentation rate and the amount of time that the implant has been in situ.
Similar articles
-
Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties.J Bone Joint Surg Am. 1999 May;81(5):672-83. doi: 10.2106/00004623-199905000-00008. J Bone Joint Surg Am. 1999. PMID: 10360695
-
The value of aspiration of the hip joint before revision total hip arthroplasty.J Bone Joint Surg Am. 1993 Jan;75(1):66-76. doi: 10.2106/00004623-199301000-00010. J Bone Joint Surg Am. 1993. PMID: 8419393
-
Perioperative testing for joint infection in patients undergoing revision total hip arthroplasty.J Bone Joint Surg Am. 2008 Sep;90(9):1869-75. doi: 10.2106/JBJS.G.01255. J Bone Joint Surg Am. 2008. PMID: 18762646
-
Sonication of Arthroplasty Implants Improves Accuracy of Periprosthetic Joint Infection Cultures.Clin Orthop Relat Res. 2017 Jul;475(7):1827-1836. doi: 10.1007/s11999-017-5315-8. Clin Orthop Relat Res. 2017. PMID: 28290115 Free PMC article. Review.
-
Prognostic value of suction drain tip culture in determining joint infection in primary and non-infected revision total hip arthroplasty: a prospective comparative study and review of the literature.Arch Orthop Trauma Surg. 2009 Dec;129(12):1645-9. doi: 10.1007/s00402-009-0844-6. Epub 2009 Mar 3. Arch Orthop Trauma Surg. 2009. PMID: 19255766 Review.
Cited by
-
Is ultrasound-guided hip aspiration more successful than fluoroscopic-guided aspiration in diagnosing prosthetic joint infection?J Bone Jt Infect. 2023 May 9;8(3):151-163. doi: 10.5194/jbji-8-151-2023. eCollection 2023. J Bone Jt Infect. 2023. PMID: 38774034 Free PMC article.
-
Total hip arthroplasty revision etiologies: a cross-sectional study in Isfahan, Iran.J Res Med Sci. 2022 Sep 27;27:70. doi: 10.4103/jrms.jrms_959_21. eCollection 2022. J Res Med Sci. 2022. PMID: 36353340 Free PMC article.
-
[Diagnosis of periprosthetic joint infection : Development of an evidence-based algorithm by the work group of implant-associated infection of the AE-(German Society for Arthroplasty)].Orthopade. 2021 Apr;50(4):312-325. doi: 10.1007/s00132-020-03940-6. Orthopade. 2021. PMID: 32666142 Free PMC article. German.
-
Synovial Fluid Aspirates Diluted with Saline or Blood Reduce the Sensitivity of Traditional and Contemporary Synovial Fluid Biomarkers.Clin Orthop Relat Res. 2020 Aug;478(8):1805-1813. doi: 10.1097/CORR.0000000000001188. Clin Orthop Relat Res. 2020. PMID: 32191417 Free PMC article.
-
Saline lavage and reaspiration for the diagnosis of periprosthetic joint infections.Ann Transl Med. 2019 Dec;7(Suppl 8):S389. doi: 10.21037/atm.2019.12.83. Ann Transl Med. 2019. PMID: 32016107 Free PMC article. No abstract available.
MeSH terms
LinkOut - more resources
Full Text Sources