Document Detail

High diagnostic value of synovial biopsy in periprosthetic joint infection of the hip.
MedLine Citation:
PMID:  22806261     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The role of the synovial biopsy in the preoperative diagnosis of a periprosthetic joint infection (PJI) of the hip has not been clearly defined.
QUESTIONS/PURPOSES: We asked whether the value of a biopsy for a PJI is greater than that of aspiration and C-reactive protein (CRP).
METHODS: Before revision in 100 hip endoprostheses, we obtained CRP values, aspirated the joint, and obtained five synovial biopsy samples for bacteriologic analysis and five for histologic analysis. Microbiologic and histologic analyses of the periprosthetic tissue during revision surgery were used to verify the results of the preoperative diagnostic methods. The minimum followup was 24 months (median 32; range, 24-47 months).
RESULTS: Forty-five of the 100 prostheses were identified as infected. The biopsy, with a combination of the bacteriologic and histologic examinations, showed the greatest diagnostic value of all the diagnostic procedures and led to a sensitivity of 82% (95% CI, ± 11%), specificity of 98% (95% CI, ± 4%), positive predictive value of 97% (95% CI, ± 5%), negative predictive value of 87% (95% CI, ± 8.3%), and accuracy of 91%.
CONCLUSIONS: The biopsy technique has a greater value than aspiration and CRP in the diagnosis of PJI of the hip (Masri et al. J Arthroplasty 22:72-78, 2007). In patients with a negative aspirate, but increased CRP or clinical signs of infection, we regard biopsy to be preferable to just repeating the aspiration.
LEVEL OF EVIDENCE: Level II prognostic study. See Guidelines for Authors for a complete description of levels of evidence.
Bernd Fink; Alexander Gebhard; Martin Fuerst; Irina Berger; Peter Schäfer
Publication Detail:
Type:  Evaluation Studies; Journal Article     Date:  2012-07-18
Journal Detail:
Title:  Clinical orthopaedics and related research     Volume:  471     ISSN:  1528-1132     ISO Abbreviation:  Clin. Orthop. Relat. Res.     Publication Date:  2013 Mar 
Date Detail:
Created Date:  2013-02-05     Completed Date:  2013-04-03     Revised Date:  2014-03-11    
Medline Journal Info:
Nlm Unique ID:  0075674     Medline TA:  Clin Orthop Relat Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  956-64     Citation Subset:  AIM; IM    
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MeSH Terms
Aged, 80 and over
Arthroplasty, Replacement, Hip / adverse effects*,  instrumentation
Bacteriological Techniques
Biological Markers / blood
Biopsy* / methods
Biopsy, Needle
C-Reactive Protein / analysis
Hip Joint / microbiology,  pathology,  surgery*
Hip Prosthesis / adverse effects*
Middle Aged
Predictive Value of Tests
Prospective Studies
Prosthesis-Related Infections / diagnosis*,  microbiology,  pathology,  surgery
Sensitivity and Specificity
Synovial Membrane / microbiology,  pathology,  surgery*
Reg. No./Substance:
0/Biological Markers; 9007-41-4/C-Reactive Protein

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