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Anatomic Landmark-Guided Hip Aspiration in the Diagnosis of Periprosthetic Joint Infection
Abstract:
Hip aspirations used to detect a periprosthetic joint infection (PJI) are usually performed under fluoroscopy or ultrasound. The aim of this study was to evaluate the results of simply using anatomic landmarks for aspiration and detecting PJI without the use of any complicated technologies. The authors retrospectively reviewed a total of 186 consecutive hip aspirations performed between April 2015 and December 2018. All patients were suspected to have infections after total hip arthroplasty. The procedures were performed with the patients in the supine position. The authors aimed to aspirate at the neck of the prosthesis. They located the y-axis of the puncture point approximately 2 to 3 cm lateral to the pulse of the femoral artery in the region of the inguinal ligament. The x-axis was estimated by using the pubic symphysis or greater trochanter according to an anteroposterior radiograph of the hip joint. The aspiration failure rate, incidence of complications, and culture results were recorded. The overall aspiration failure rate was 3.8% (7 of 186). No obvious complications related to aspiration were observed. The saline lavage and reaspiration rate was 45.3% (81 of 179) due to "dry taps." The sensitivity, specificity, positive predictive value, and negative predictive value of the remaining 169 patients with definite diagnoses were 0.781 (95% CI, 0.678-0.860), 0.939 (95% CI, 0.857-0.977), 0.931 (95% CI, 0.841-0.975), and 0.802 (95% CI, 0.706-0.874), respectively. Anatomic landmark-guided hip aspiration was a convenient method that could provide satisfactory detection of PJI. [Orthopedics. 2021;44(1):e85-e90.].
Insights
Hip aspirations using anatomic landmarks effectively detect periprosthetic joint infection (PJI) without advanced imaging. This simple method shows good accuracy for diagnosing PJI in patients with suspected hip arthroplasty infections.
Area of Science:
- Orthopedics
- Infectious Diseases
- Surgical Innovation
Background:
- Periprosthetic joint infection (PJI) diagnosis often relies on imaging-guided hip aspirations.
- Fluoroscopy and ultrasound are common but complex technologies for guiding hip aspiration.
- A simpler, landmark-based approach could improve accessibility and reduce costs.
Purpose of the Study:
- To evaluate the efficacy of hip aspiration guided solely by anatomic landmarks for detecting PJI.
- To assess the feasibility of this technique without specialized imaging technologies.
- To determine the accuracy and complication rates of landmark-guided hip aspiration.
Main Methods:
- Retrospective review of 186 hip aspirations in patients with suspected PJI post-total hip arthroplasty.
- Procedures performed using anatomic landmarks to locate the aspiration site near the prosthesis neck.
- Data collected on aspiration failure rate, complications, and diagnostic accuracy (sensitivity, specificity, PPV, NPV).
Main Results:
- Overall aspiration failure rate was low at 3.8%.
- No significant complications were observed.
- The method demonstrated good diagnostic accuracy: sensitivity 0.781, specificity 0.939, PPV 0.931, NPV 0.802.
Conclusions:
- Anatomic landmark-guided hip aspiration is a convenient and effective method for PJI detection.
- This technique offers satisfactory diagnostic performance without requiring complex technologies.
- It presents a viable alternative for diagnosing PJI in resource-limited settings or for simplifying procedures.
