scholarly journals The significance of synovial biopsy in the diagnostic workup of the low-grade periprosthetic joint infection of shoulder arthroplasty

2021 ◽  
Author(s):  
Moritz Mederake ◽  
Ulf Krister Hofmann ◽  
Bernd Fink
Keyword(s):  
Revision Surgery ◽  
Periprosthetic Joint Infection ◽  
Shoulder Arthroplasty ◽  
Joint Infection ◽  
Diagnostic Value ◽  
Synovial Biopsy ◽  
Diagnostic Workup ◽  
Low Grade ◽  
Diagnostic Challenge ◽  
Shoulder Arthroplasties

Abstract Introduction A common reason for painful shoulder arthroplasties and revision surgery is a low-grade periprosthetic joint infection (PJI). Diagnosing a low-grade infection is, however, a major diagnostic challenge. This applies even more to the shoulder, which differs from other large joints in terms of clinical features and microbiological spectrum. Aim of this study was to evaluate the diagnostic value of the synovial biopsy in the diagnostic workup of low-grade PJI of the shoulder. Materials and methods A retrospective evaluation was conducted on 56 patients receiving revision surgery on their shoulder arthroplasty. A standardized preoperative workup was performed comprising CRP value, leukocyte blood count, synovial fluid microbiological analyses and leukocyte count from joint aspiration, and five synovial biopsy samples for bacteriologic and histologic analysis obtained through an arthroscopic approach. During revision surgery, five samples of periprosthetic tissue were harvested for bacteriologic and histologic analyses. The MSIS-Criteria 2014 were used to evaluate the diagnostic results. Results In total, 15 of 56 revised prostheses turned out as PJI (27%). When applying our diagnostic workup, we obtained a sensitivity of 67% with a specificity of 95%. When performing a subgroup analysis on those patients that had received diagnostic biopsy, a sensitivity of 100% and a specificity of 83% could be achieved. With a sensitivity and specificity of 90% and 83%, respectively, the biopsy is the single method with the highest diagnostic value. Conclusions The sensitivity of only 67% of our standard workup emphasizes the difficulty to adequately diagnose low-grade infections after shoulder arthroplasty. The excellent specificity of 95% ensures, however, that non-infected prostheses are not incorrectly explanted. This study highlights that synovial biopsy has a high diagnostic value and should be done prior to complex revision surgeries to raise sensitivity in diagnosing a PJI.

Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee – Evaluation of an Evidence-based Algorithm

2019 ◽  
Vol 157 (06) ◽  
pp. 684-694
Author(s):  
Christian Scheele ◽  
Isabelle Krauel ◽  
Florian Pohlig ◽  
Heinrich Muehlhofer ◽  
Ludger Gerdesmeyer ◽  
...  
Keyword(s):  
Chronic Pain ◽  
Revision Surgery ◽  
Joint Infection ◽  
Clinical Suspicion ◽  
Synovial Biopsy ◽  
Histological Evaluation ◽  
Low Grade ◽  
Multiple Biopsies ◽  
Histologic Evaluation ◽  
Made In

Abstract Background Periprosthetic joint infection (PPI) is one of the most common reasons for revision in total knee arthroplasty (TKA). Percutaneous synovial biopsy is considered as a well-established diagnostic tool in ambiguous cases of chronic pain after TKA. The exact number of undetected low-grade infections remains unclear. Objectives The aim of this prospective study was to compare the diagnostic accuracy of arthroscopically guided and unguided synovial biopsy. Additionally, the prevalence of initially undetected PPI during synovial biopsy and revision surgery was assessed. Materials and Methods 40 patients suffering from chronic pain after TKA and the clinical suspicion of PPI were included in the study. Synovial biopsies were collected in a standardized manner first without and then with arthroscopic visual control. Using both techniques, six samples were collected each (5 for microbiology, 1 for histology). 19 patients, initially classified aseptic, underwent revision surgery later. Results The diagnosis of PPI was made in 10.0% of unguided biopsies (4 cases, 2× microbiologically, 2× histologically), 7.5% of arthroscopic biopsies (3 cases, 3× histologically) and 12.5% (5 cases, 3× histologically, 2× microbiologically) of all cases. Only histologic evaluation led to concordant positive findings using both techniques in two patients. The proportion of non-representative biopsies was twice as high after unguided tissue collection than after arthroscopic biopsy (30.0 vs. 15.0%). Microbiologic evaluation of arthroscopically collected biopsies did not lead to the diagnosis of PPI, which might have been essential to the selection of the appropriate antimicrobial therapy. During revision surgery the diagnosis of PPI was made in 22.2% of cases. Conclusions In patients suffering from chronic pain after TKA, periprosthetic low-grade infection was diagnosed in a relevant proportion of cases. Therefore, synovial biopsies for histological and microbiological evaluation should be collected whenever thereʼs clinical suspicion of PPI. For histological evaluation, samples should be collected using arthroscopic control and ideally multiple biopsies should be taken. For microbiological evaluation, excessive joint lavage should be avoided.

scholarly journals Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection. A retrospective single-center experience

2022 ◽  
Vol 7 (1) ◽  
pp. 1-9
Author(s):  
Karsten D. Ottink ◽  
Stefan J. Gelderman ◽  
Marjan Wouthuyzen-Bakker ◽  
Joris J. W. Ploegmakers ◽  
Andor W. J. M. Glaudemans ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Revision Surgery ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
A Priori ◽  
Nuclear Imaging ◽  
Added Value ◽  
Low Grade ◽  
Predictive Values ◽  
Sensitivity Specificity

Abstract. Background: A low-grade periprosthetic joint infection (PJI) may present without specific symptoms, and its diagnosis remains a challenge. Three-phase bone scintigraphy (TPBS) and white blood cell (WBC) scintigraphy are incorporated into recently introduced diagnostic criteria for PJI, but their exact value in diagnosing low-grade PJI in patients with nonspecific symptoms remains unclear. Methods: In this retrospective study, we evaluated patients with a prosthetic joint of the hip or knee who underwent TPBS and/or WBC scintigraphy between 2009 and 2016 because of nonspecific symptoms. We reviewed and calculated diagnostic accuracy of the TPBS and/or WBC scintigraphy to diagnose or exclude PJI. PJI was defined based on multiple cultures obtained during revision surgery. In patients who did not undergo revision surgery, PJI was ruled out by clinical follow-up of at least 2 years absent of clinical signs of infection based on MSIS 2011 criteria. Results: A total of 373 patients were evaluated, including 340 TPBSs and 142 WBC scintigraphies. Thirteen patients (3.5 %) were diagnosed with a PJI. TPBS sensitivity, specificity, and positive and negative predictive values (PPV, NPV) were 71 %, 65 %, 8 % and 98 %, respectively. Thirty-five percent of TPBS showed increased uptake. Stratification for time intervals between the index arthroplasty and the onset of symptoms did not alter its diagnostic accuracy. WBC scintigraphy sensitivity, specificity, PPV and NPV were 30 %, 90 %, 25 % and 94 %, respectively. Conclusion: Nuclear imaging does not have clear added value in patients with low a priori chance of periprosthetic joint infection.

scholarly journals High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

2013 ◽  
Vol 471 (3) ◽  
pp. 956-964 ◽  
Author(s):  
Bernd Fink ◽  
Alexander Gebhard ◽  
Martin Fuerst ◽  
Irina Berger ◽  
Peter Schäfer
Keyword(s):  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Diagnostic Value ◽  
Synovial Biopsy

scholarly journals Synovial Complement Factors in Patients with Periprosthetic Joint Infection after Undergoing Revision Arthroplasty of the Hip or Knee Joint

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 434
Author(s):  
Frank Sebastian Fröschen ◽  
Sophia Schell ◽  
Matthias Dominik Wimmer ◽  
Gunnar Thorben Rembert Hischebeth ◽  
Hendrik Kohlhof ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Multiple Regression ◽  
Complement System ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Expression Patterns ◽  
Factor H ◽  
Low Grade ◽  
Complement Factors ◽  
Fluid Levels

The role and diagnostic value of the synovial complement system in patients with low-grade periprosthetic joint infection (PJI) are unclear. We sought to evaluate, for the first time, the usefulness of synovial complement factors in these patients by measuring the individual synovial fluid levels of complement factors (C1q, C3b/iC3b, C4b, C5, C5a, C9, factor B, factor D, factor H, factor I, properdin, and mannose-binding lectin [MBL]). The patients (n = 74) were classified into septic (n = 28) and aseptic (n = 46). Receiver-operator characteristic curves and a multiple regression model to determine the feasibility of a combination of the tested cytokines to determine the infection status were calculated. The synovial fluid levels of C1q, C3b/C3i, C4b, C5, C5a, MBL, and properdin were significantly elevated in the PJI group. The best sensitivity and specificity was found for C1q. The multiple regression models revealed that the combination of C1q, C3b/C3i, C4b, C5, C5a, and MBL was associated with the best sensitivity (83.3%) and specificity (79.2%) for a cutoff value of 0.62 (likelihood ratio: 4.0; area under the curve: 0.853). Nevertheless, only a combined model showed acceptable results. The expression patterns of the complement factors suggested that PJI activates all three pathways of the complement system.

Periprosthetic Joint Infection after Shoulder Arthroplasty

2021 ◽  
pp. 213-229
Author(s):  
Parham Sendi ◽  
Andreas Marc Müller ◽  
Beat K. Moor ◽  
Matthias A. Zumstein
Keyword(s):  
Periprosthetic Joint Infection ◽  
Shoulder Arthroplasty ◽  
Joint Infection

Diagnosis and Management of Periprosthetic Joint Infection After Shoulder Arthroplasty

JBJS Reviews ◽  
2019 ◽  
Vol 7 (7) ◽  
pp. e3-e3 ◽  
Author(s):  
Maxwell E. Cooper ◽  
Nikunj N. Trivedi ◽  
Lakshmanan Sivasundaram ◽  
Michael R. Karns ◽  
James E. Voos ◽  
...  
Keyword(s):  
Periprosthetic Joint Infection ◽  
Shoulder Arthroplasty ◽  
Joint Infection ◽  
Diagnosis And Management

scholarly journals Salmonella Sp. as the Cause of Periprosthetic Joint Infection of the Hip: Report of a Rare Case and Literature Review

2020 ◽  
Vol 8 (5_suppl5) ◽  
pp. 2325967120S0004
Author(s):  
Asep Santoso ◽  
Iwan Budiwan Anwar ◽  
Tangkas Sibarani ◽  
Bintang Soetjahjo ◽  
Ismail Mariyanto
Keyword(s):  
Total Hip Arthroplasty ◽  
Literature Review ◽  
Antibiotic Treatment ◽  
Hip Arthroplasty ◽  
Revision Surgery ◽  
Periprosthetic Joint Infection ◽  
Rare Case ◽  
Joint Infection ◽  
Immunosuppressed Patient ◽  
Cement Spacer

Periprosthetic joint infection of the hip due to Salmonella sp. is rare. It is sometimes difficult to treat and needed a prolonged antibiotic treatment. We reported a case of periprosthetic joint infection of the hip in a 67 years old female who received prior left total hip arthroplasty. Two-stage revision surgery with antibiotic-loaded cement spacer has been performed to the patient and successfully control the infection. Review of the literatures also has been done. Salmonella Sp. has to be considered as one of differential etiology in the case of infected arthroplasty especially in an immunosuppressed patient. It showed still there has been no consensus in the treatment of choice for this particular case.

scholarly journals Is Procalcitonin (PCT) a reliable biomarker for preoperative diagnosing of low grade Periprosthetic Joint Infection? A Prospective Study

2019 ◽  
Author(s):  
André Busch ◽  
Marcus Jäger ◽  
Harald Engler ◽  
Marcel Haversath ◽  
Charlotte Bielefeld ◽  
...  
Keyword(s):  
Synovial Fluid ◽  
Periprosthetic Joint Infection ◽  
Joint Infection ◽  
Laboratory Data ◽  
Joint Fluid ◽  
Low Grade ◽  
Synovial Joint ◽  
Knee Infection ◽  
The Mean ◽  
Definition Of

Abstract Background: Since a „gold-standard“ is missing, diagnosing periprosthetic joint infection (PJI) remains a challenge in orthopedic surgery. The purpose of this study was to evaluate the accuracy of serum and synovial fluid Procalcitonin (S-PCT and SF-PCT) as a diagnostic parameter and to compare it to the biomarkers recommended in the 2018 Definition of periprosthetic hip and knee infection. Methods: Between August 2018 and July 2019, a prospective cohort study was conducted in 70 patients with painful hip, shoulder and knee arthroplasty. Besides medical history, clinical and laboratory data was gathered. PJI was diagnosed based on the 2018 Definition of periprosthetic hip and knee infection. Preoperative blood and synovial joint fluid were taken for PCT measurement. S-PCT levels were quantified under the use of immunoassay (Centaur, Siemens, Germany). SF- PCT levels were measured using a standard quantitative PCT enzyme immunoassay kit, according to the manufacturers' instructions (Anti-Procalcitonin antibody ab166963, ABCAM, Cambridge,UK). Results: Twenty three patients (33%) were classified as the PJI group and fourty seven patient (67%) as the aseptic group. The mean levels of S-PCT were significantly (p<0.001) higher than those in the aseptic group (PJI 0.05 ng/mL (0.0-1.03) vs. aseptic 0.02 ng/mL (0.0-0.18)). In synovial fluid, the mean PCT values in the aseptic group were significantly higher (p<0.001) than those of PJI group (PJI 2.7 ng/mL (0.53-9.7) vs. aseptic 8.7 ng/mL (0.25-87.9)). S- PCT, with a cut-off level of 0.5 ng/mL, had a sensitivity of 13.0% and a specifity of 91.0%. SF-PCT, with a cut-off level of 5.0 ng/mL, had a sensitivity of 13.0% and a specifity of 52.0%. Conclusion: S-PCT and SF-PCT appeared to be no reliable biomarkers in the differential diagnosis of PJI from aseptic loosening in total joint arthroplasty.

scholarly journals Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

2020 ◽  
Author(s):  
Cheng Li ◽  
Donara Margaryan ◽  
Cristina Ojeda-Thies ◽  
Carsten Perka ◽  
Andrej Trampuz
Keyword(s):  
Likelihood Ratio ◽  
Periprosthetic Joint Infection ◽  
Degradation Products ◽  
Meta Analysis ◽  
Joint Infection ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Diagnostic Value ◽  
Medical Subject Headings ◽  
D Dimer

Abstract Background The purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI). Methods A systematic search and screen of relevant studies was performed in the PubMed, Web of Science and Embase databases using the following medical subject headings (MeSH) or keywords: “arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint”, “infection or infectious or infected”, and “D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products”. Then, the data were analysed and processed by Meta-Disc software. Results A total of 7 studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR) and diagnostic odds ratio (DOR) were 0.75 (95% confidence interval [CI]: 0.70 to 0.79), 0.69 (95% CI: 0.66 to 0.72), 3.01 (95% CI: 1.84 to 4.93), 0.32 (95% CI: 0.19 to 0.53) and 10.20 (95% CI: 3.63 to 28.64), respectively. Subgroup analyses showed that use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI (0.86, 0.84 vs. 0.67, 0.60, respectively). Conclusion Serum D-dimer had a better diagnostic value than plasma D-dimer for the diagnosis of PJI.

scholarly journals Meta-analysis of serum and/or plasma D-dimer in the diagnosis of periprosthetic joint infection

2020 ◽  
Author(s):  
Cheng Li ◽  
Donara Margaryan ◽  
Cristina Ojeda-Thies ◽  
Carsten Perka ◽  
Andrej Trampuz
Keyword(s):  
Likelihood Ratio ◽  
Periprosthetic Joint Infection ◽  
Degradation Products ◽  
Meta Analysis ◽  
Joint Infection ◽  
Positive Likelihood Ratio ◽  
Negative Likelihood Ratio ◽  
Diagnostic Value ◽  
Medical Subject Headings ◽  
D Dimer

Abstract Background The purpose of this meta-analysis was to evaluate the diagnostic value of D-dimer in detecting periprosthetic joint infection (PJI). Methods A systematic search and screening of relevant studies was performed in the databases PubMed, Web of Science, and Embase using the following medical subject headings (MeSH) or keywords: “arthroplasty or joint prosthesis or joint replacement or periprosthetic joint or prosthetic joint”, “infection or infectious or infected”, and “D-dimer or serum D-dimer or plasma D-dimer or fibrin degradation products”. Data were subsequently analysed and processed using Meta-Disc. Results Seven studies with 1285 patients were included in this meta-analysis. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio were 0.75 (95% confidence interval [CI]: 0.70–0.79), 0.69 (95% CI: 0.66–0.72), 3.01 (95% CI: 1.84–4.93), 0.32 (95% CI: 0.19–0.53), and 10.20 (95% CI: 3.63–28.64), respectively. Subgroup analyses showed that the use of serum D-dimer had better sensitivity and specificity than plasma D-dimer for the diagnosis of PJI . Conclusion Serum D-dimer was shown to have a better diagnostic value than plasma D-dimer for the diagnosis of PJI. Further research is required for clarification.

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