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Fluoroscopy- vs ultrasound-guided aspiration techniques in the management of periprosthetic joint infection: which is
Filippo Randelli1, Marco Brioschi2,3, Pietro Randelli4
1Hip Department, Orthopedics and Trauma V, IRCCS Policlinico San Donato, S. Donato Milanese, Milan, Italy.
Background:
Fluid samples obtained from an affected joint still play a central role in the diagnosis of periprosthetic joint infection (PJI). It is the only preoperative test able to discover the causative microbiological agent. In the hip, fluid aspiration can be performed through fluoroscopy, ultrasound, or, less commonly, computed tomography. However, there is still a lack of consensus on which method is preferable in terms of efficacy and costbenefit.
Purposes:
We, therefore, asked whether (1) the benefits in terms of sensitivity and specificity and (2) the costs were comparable between fluoroscopy- and ultrasound-guided joint aspirations in a suspicious of hip PJI.
Methods:
Between 2013 and 2016, 52 hip aspirations were performed on 49 patients with clinical, radiological, or serological suspicion of PJI, waiting for a revision surgery. The patients were divided in two groups: fluoroscopy- (n = 26) vs ultrasound-guided hip aspiration group (n = 26). These groups were also divided in control and infected patients. The criteria of MusculoSkeletal Infection Society (MSIS) were used, as gold standard, to define PJI.
Results:
(1) Ultrasound-guided aspiration revealed valid sensitivity (89% vs 60%) and specificity (94% vs 81%) in comparison with fluoroscopic-guided aspiration. (2) The cost analysis was also in favor of ultrasound-guided aspiration (125.30€) than fluoroscopic-guided aspiration (343.58€).
Conclusions:
We concluded that ultrasound-guided hip aspiration could represent a valid, safe, and less expensive diagnostic alternative to fluoroscopic-guided aspiration in hip PJI.
Insights
Ultrasound-guided hip aspiration is a more sensitive and specific diagnostic tool for periprosthetic joint infection (PJI) than fluoroscopy. This method is also significantly more cost-effective for diagnosing hip PJI.
Area of Science:
- Orthopedic surgery
- Diagnostic imaging
- Infectious disease
Background:
- Periprosthetic joint infection (PJI) diagnosis relies heavily on joint fluid analysis.
- Current methods for hip fluid aspiration include fluoroscopy and ultrasound, with no clear consensus on the preferred technique.
- Accurate preoperative diagnosis is crucial for effective PJI management.
Purpose of the Study:
- To compare the diagnostic efficacy (sensitivity and specificity) of ultrasound-guided versus fluoroscopy-guided hip aspiration.
- To evaluate the cost-effectiveness of each aspiration method for suspected hip PJI.
Main Methods:
- A comparative study involving 52 hip aspirations in 49 patients with suspected PJI between 2013 and 2016.
- Patients were divided into two equal groups: fluoroscopy-guided (n=26) and ultrasound-guided (n=26).
- The Musculoskeletal Infection Society (MSIS) criteria were used as the gold standard for PJI diagnosis.
Main Results:
- Ultrasound-guided aspiration demonstrated superior sensitivity (89% vs. 60%) and specificity (94% vs. 81%) compared to fluoroscopy-guided aspiration.
- Cost analysis favored ultrasound-guided aspiration (€125.30) over fluoroscopy-guided aspiration (€343.58).
Conclusions:
- Ultrasound-guided hip aspiration is a highly effective diagnostic alternative for periprosthetic joint infection.
- This method offers improved accuracy and significant cost savings compared to fluoroscopy-guided aspiration.
- Ultrasound guidance is recommended as a safe, valid, and less expensive option for diagnosing hip PJI.