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Pre-operative intra-articular deep tissue sampling with novel retrograde forceps improves the diagnostics in
Matthias D Wimmer1, Milena M Ploeger2, Max J Friedrich2
1Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany. wimmer@uni-bonn.de.
Background:
Histopathological tissue analysis is a key parameter within the diagnostic algorithm for suspected periprosthetic joint infections (PJIs), conventionally acquired in open surgery. In 2014, Hügle and co-workers introduced novel retrograde forceps for retrograde synovial biopsy with simultaneous fluid aspiration of the knee joint. We hypothesised that tissue samples acquired by retrograde synovial biopsy are equal to intra-operatively acquired deep representative tissue samples regarding bacterial detection and differentiation of periprosthetic infectious membranes.
Method:
Thirty patients (male n = 15, 50%; female n = 15, 50%) with 30 suspected PJIs in painful total hip arthroplasties (THAs) were included in this prospective, controlled, non-blinded trial. The results were compared with intra-operatively obtained representative deep tissue samples.
Results:
In summary, 27 out of 30 patients were diagnosed correctly as infected (17/17) or non-infected (10/13). The sensitivity to predict a PJI using the Retroforce® sampling forceps in addition to standard diagnostics was 85%, the specificity 100%.
Conclusions:
Retrograde synovial biopsy is a new and rapid diagnostic procedure under local anaesthesia in patients with painful THAs with similar histological results compared to deep tissue sampling.
Insights
Retrograde synovial biopsy using specialized forceps offers a rapid, minimally invasive method for diagnosing periprosthetic joint infections (PJIs). This technique provides diagnostic accuracy comparable to traditional surgical biopsies, improving patient care for suspected hip infections.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnostics
- Biomedical Engineering
Background:
- Histopathological analysis of tissue is crucial for diagnosing periprosthetic joint infections (PJIs).
- Conventional methods involve open surgery, which can be invasive.
- Novel retrograde forceps allow for synovial biopsy and fluid aspiration, offering a less invasive approach.
Purpose of the Study:
- To evaluate the efficacy of retrograde synovial biopsy for diagnosing PJIs.
- To compare the diagnostic accuracy of retrograde biopsy with traditional intra-operative deep tissue sampling.
Main Methods:
- A prospective trial included 30 patients with suspected PJIs in total hip arthroplasties (THAs).
- Tissue samples were obtained using retrograde synovial biopsy forceps (Retroforce®).
- Results were compared to intra-operatively acquired deep tissue samples.
Main Results:
- The retrograde biopsy method correctly diagnosed 27 out of 30 patients (90%).
- Sensitivity for PJI detection was 85%, with 100% specificity.
- Histological results were comparable to deep tissue sampling.
Conclusions:
- Retrograde synovial biopsy is a rapid, effective diagnostic procedure for painful THAs.
- Performed under local anesthesia, it yields similar histological results to deep tissue sampling.
- This minimally invasive technique aids in PJI diagnosis.
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