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Is there a role for tissue biopsy in the diagnosis of periprosthetic infection?
Geert Meermans1, Fares S Haddad
1University College London Hospital, London, UK. geertmeermans@hotmail.com
Background:
Successful treatment of an infected joint arthroplasty depends on correctly identifying the responsible pathogens. The value of a preoperative biopsy remains controversial.
Questions/Purposes:
We (1) compared the sensitivity and specificity of both tests separately and in combination, and (2) asked whether the combination of tissue biopsy and aspiration would improve our diagnostic yield in the evaluation of periprosthetic joint infections.
Patients And Methods:
We prospectively followed 120 patients with suspected infection of a total joint arthroplasty: 64 with THAs and 56 with TKAs. All patients had aspiration with culture and biopsy.
Results:
The sensitivity was 83% for aspiration, 79% for biopsy, and 90% for the combination of both techniques. The specificity was 100% for aspiration and biopsy and the combination. The overall accuracy was 84%, 81%, and 90%, respectively.
Conclusions:
Our data suggest tissue biopsy alone offers no clear advantage over joint aspiration. However, the combination of both techniques provides improved sensitivity and accuracy. We recommend the use of tissue biopsy as an adjunct to joint aspiration in the diagnosis of total joint infection.
Level Of Evidence:
Level II, diagnostic study. See the Guidelines for Authors for a complete description of levels of evidence.
Insights
Combining joint aspiration and tissue biopsy significantly improves the diagnosis of periprosthetic joint infections, offering higher sensitivity and accuracy than either method alone.
Area of Science:
- Orthopedic surgery
- Infectious disease diagnostics
- Medical microbiology
Background:
- Accurate pathogen identification is crucial for treating infected joint arthroplasty.
- The diagnostic utility of preoperative biopsy for periprosthetic joint infections is debated.
Purpose of the Study:
- To compare the sensitivity and specificity of joint aspiration and tissue biopsy, individually and combined.
- To determine if combining aspiration and biopsy enhances diagnostic yield for periprosthetic joint infections.
Main Methods:
- Prospective study of 120 patients with suspected infected total joint arthroplasty (64 THAs, 56 TKAs).
- All patients underwent joint aspiration with culture and tissue biopsy.
Main Results:
- Combined sensitivity reached 90%, compared to 83% for aspiration and 79% for biopsy.
- Specificity was 100% for all methods (aspiration, biopsy, and combination).
- Overall accuracy was highest with the combination (90%).
Conclusions:
- Tissue biopsy alone does not offer a significant advantage over joint aspiration for diagnosing infected joint arthroplasty.
- The combination of tissue biopsy and joint aspiration improves diagnostic sensitivity and accuracy.
- Tissue biopsy is recommended as an adjunct to joint aspiration for diagnosing total joint infections.
