Article

The value of synovial biopsy, joint aspiration and C-reactive protein in the diagnosis of late periprostethic infection of total knee replacements. J Bone Joint Surg Br

Department of Joint Replacement, General and Rheumatic Orthopaedics, Orthopaedic Clinic, Markgröningen, Kurt-Lindemann-Weg 10, 71706 Markgröningen, Germany.
The Bone & Joint Journal (Impact Factor: 2.8). 08/2008; 90(7):874-8. DOI: 10.1302/0301-620X.90B7.20417
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ABSTRACT We analysed the serum C-reactive protein level, synovial fluid obtained by joint aspiration and five synovial biopsies from 145 knee replacements prior to revision to assess the value of these parameters in diagnosing late peri-prosthetic infection. Five further synovial biopsies were used for histological analysis. Samples were also obtained during the revision and incubated and analysed in an identical manner for 14 days. A total of 40 total knee replacements were found to be infected (prevalence 27.6%). The aspiration technique had a sensitivity of 72.5% (95% confidence interval (CI) 58.7 to 86.3), a specificity of 95.2% (95% CI 91.2 to 99.2), a positive predictive value of 85.3% (95% CI 73.4 to 100), a negative predictive value of 90.1% (95% CI 84.5 to 95.7) and an accuracy of 89%. The biopsy technique had a sensitivity of 100%, a specificity of 98.1% (95% CI 95.5 to 100), a positive predictive value of 95.2% (95% CI 88.8 to 100), a negative predictive value of 100% and an accuracy of 98.6%. C-reactive protein with a cut-off-point of 13.5 mg/l had a sensitivity of 72.5% (95% CI 58.7 to 86.3), a specificity of 80.9% (95% CI 73.4 to 88.4), a positive predictive value of 59.2% (95% CI 45.4 to 73.0), a negative predictive value of 88.5% (95% 81.0 to 96.0 CI) and an accuracy of 78.1%. We found that biopsy was superior to joint aspiration and C-reactive protein in the diagnosis of late peri-prosthetic infection of total knee replacements.

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Available from: Bernd Fink, Dec 03, 2014
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    • "Several diagnostic modalities such as laboratory tests (white blood cell count, ESR, CRP, Il-6, TNF-í µí»¼, and procalcitonin C), synovial fluid characteristics, histopathological studies of intraoperative samples of periprosthetic tissue, microbiological studies (conventional cultures of five to six intraoperative specimens of periprosthetic tissue), and radiological studies (predominately technetium-methylene diphosphonate (MDP) bone scintigraphy) can be applied to identify the pathogen [23]; however differential diagnosis of low-grade infections can be extremely challenging. Sensitivity and specificity of the aforementioned methods are currently not optimal for single use for the diagnosis of PJI, although several studies have shown that histopathology has a superior sensitivity compared to the microbiological and laboratory exams [24] [25] [26]. However, histological diagnosis has the disadvantage that the causative pathogen cannot be identified and so the optimal antibiotic treatment cannot be administered. "
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    ABSTRACT: Background. Periprosthetic joint infection (PJI) is the most severe complication, following joint arthroplasty. Identification of the causal microbial factor is of paramount importance for the successful treatment. Purpose. The aim of this study is to compare the sonication fluid cultures derived from joint prosthetic components with the respective periprosthetic tissue cultures. Methods. Explanted prosthesis components for suspected infection were placed into a tank containing sterile Ringer's solution and sonicated for 1 minute at 40 kHz. Sonication fluid cultures were examined for 10 days, and the number and identity of any colony morphology was recorded. In addition, periprosthetic tissue specimens (>5) were collected and cultured according to standard practice. The duration of antimicrobial interruption interval before culture sampling was recorded. Results. Thirty-four patients composed the study group. Sonication fluid cultures were positive in 24 patients (70.5%). Sixteen of thirty four periprosthetic tissue cultures (47.1%) were considered positive, all revealing the same microbial species with the respective sonication fluid cultures: 3 tissue samples showed polymicrobial infection. All tissue cultures were also found positive by the sonication fluid culture. Conclusions. Sonication fluid cultures represent a cheap, easy, accurate, and sensitive diagnostic modality demonstrating increased sensitivity compared to periprosthetic tissue cultures (70.5 versus 47.1%).
    The Scientific World Journal 10/2013; 2013:375140. DOI:10.1155/2013/375140 · 1.73 Impact Factor
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    • "Several diagnostic modalities such as laboratory tests (white blood cell count, ESR, CRP, Il-6, TNF-í µí»¼, and procalcitonin C), synovial fluid characteristics, histopathological studies of intraoperative samples of periprosthetic tissue, microbiological studies (conventional cultures of five to six intraoperative specimens of periprosthetic tissue), and radiological studies (predominately technetium-methylene diphosphonate (MDP) bone scintigraphy) can be applied to identify the pathogen [23]; however differential diagnosis of low-grade infections can be extremely challenging. Sensitivity and specificity of the aforementioned methods are currently not optimal for single use for the diagnosis of PJI, although several studies have shown that histopathology has a superior sensitivity compared to the microbiological and laboratory exams [24] [25] [26]. However, histological diagnosis has the disadvantage that the causative pathogen cannot be identified and so the optimal antibiotic treatment cannot be administered. "
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    ABSTRACT: Background. Periprosthetic joint infection (PJI) is the most severe complication, following joint arthroplasty. Identification of the causal microbial factor is of paramount importance for the successful treatment. Purpose. The aim of this study is to compare the sonication fluid cultures derived from joint prosthetic components with the respective periprosthetic tissue cultures. Methods. Explanted prosthesis components for suspected infection were placed into a tank containing sterile Ringer's solution and sonicated for 1 minute at 40 kHz. Sonication fluid cultures were examined for 10 days, and the number and identity of any colony morphology was recorded. In addition, periprosthetic tissue specimens (>5) were collected and cultured according to standard practice. The duration of antimicrobial interruption interval before culture sampling was recorded. Results. Thirty-four patients composed the study group. Sonication fluid cultures were positive in 24 patients (70.5%). Sixteen of thirty four periprosthetic tissue cultures (47.1%) were considered positive, all revealing the same microbial species with the respective sonication fluid cultures: 3 tissue samples showed polymicrobial infection. All tissue cultures were also found positive by the sonication fluid culture. Conclusions. Sonication fluid cultures represent a cheap, easy, accurate, and sensitive diagnostic modality demonstrating increased sensitivity compared to periprosthetic tissue cultures (70.5 versus 47.1%).
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    • "The synovial fluid was incubated for 14 days (Fink et al. 2008). Antibiotics were stopped at least 2 weeks before joint aspiration. "
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    ABSTRACT: Background and purpose Mechanically failed internal fixation following hip fracture is often treated by salvage arthroplasty. If deep wound infection is present, a 2-stage procedure is often used. We have used a 1-stage procedure in infected cases, and we now report the outcome. Patients and methods We reviewed 16 cases of deep wound infection after mechanically failed hip fracture fixation, treated between 1994 and 2010. In all patients, a joint prosthesis was implanted in a 1-stage procedure. Results After an average follow-up period of 12 (2–18) years, no reinfection was detected. In 4 cases, a hip dislocation occurred and 3 of these needed further surgery. Interpretation A 1-stage procedure for arthroplasty of an infected, mechanically failed hip fracture fixation is feasible and carries a low risk of infection.
    Acta Orthopaedica 06/2013; 84(4). DOI:10.3109/17453674.2013.810520 · 2.45 Impact Factor
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