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Arthroscopic tissue biopsy as a preoperative diagnostic test for periprosthetic shoulder arthroplasty infections: a
Jimmy Tat1, Jennifer Tat2, Kenneth Faber3
1Division of Orthopaedic Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
Background:
The diagnosis of periprosthetic infection in shoulder arthroplasty remains a challenge. Conventional methods for evaluating periprosthetic joint infections are poor because of lower-virulence organisms affecting the shoulder. The aim of our systematic review was to evaluate the diagnostic accuracy of preoperative arthroscopic tissue cultures compared with tissue biopsy samples obtained at the time of revision surgery.
Materials And Methods:
We conducted a systematic search of the MEDLINE, Embase, and Cochrane Central databases. The inclusion criteria consisted of studies that used arthroscopy to obtain preoperative tissue cultures for the diagnosis of shoulder arthroplasty infections. Studies were excluded if they obtained non-arthroscopic tissue samples. We reported the sensitivity, specificity, positive predictive value, and negative predictive value. Culture findings from the arthroscopic biopsy samples were also compared with conventional tests of fluoroscopy-guided joint aspiration and serum inflammatory marker testing (positive erythrocyte sedimentation rate or C-reactive protein) within the included studies. A meta-analysis was performed to assess the overall diagnostic accuracy of the studies.
Results:
Our search strategy yielded 795 potentially relevant publications; 572 underwent title and abstract screening, and 14 studies underwent full-text review, of which 7 were included in our systematic review. The studies represented a balance of shoulder arthroplasty types, including anatomic total shoulder arthroplasty (n = 75, 38%), reverse total shoulder arthroplasty (n = 60, 30%), and hemiarthroplasty (n = 64, 32%). There were 56 of 120 arthroscopic procedures that returned positive tissue culture findings compared with 64 of 157 positive open biopsy culture findings obtained from revision surgery. The meta-analysis total for sensitivity and specificity for all studies combined indicated that arthroscopic tissue cultures (0.76 [95% confidence interval (CI), 0.57-0.88] and 0.91 [95% CI, 0.79-0.97], respectively) were superior to both aspiration (0.15 [95% CI, 0.03-0.48] and 0.93 [95% CI, 0.65-0.99], respectively) and a positive erythrocyte sedimentation rate or C-reactive protein level (0.14 [95% CI, 0.02-0.62] and 0.83 [95% CI, 0.56-0.95], respectively) in diagnosing periprosthetic shoulder infections.
Conclusions:
Our systematic review demonstrated that preoperative arthroscopic tissue biopsy used for microbiology cultures accurately predicts intraoperative culture findings obtained during revision surgery with high sensitivity and specificity. Additionally, arthroscopy appears to be superior to conventional techniques of joint aspiration and inflammatory marker testing. Therefore, arthroscopic tissue cultures may be an emerging useful tool to help guide the management of periprosthetic infections in shoulder arthroplasty.
Insights
Diagnosing periprosthetic shoulder infections is challenging. Preoperative arthroscopic tissue cultures accurately predict infection, proving superior to conventional methods like joint aspiration and inflammatory markers.
Area of Science:
- Orthopedic Surgery
- Infectious Disease Diagnostics
- Biomarker Analysis
Background:
- Periprosthetic joint infection (PJI) diagnosis in shoulder arthroplasty is difficult due to lower-virulence organisms.
- Conventional diagnostic methods often yield suboptimal results for shoulder PJIs.
Approach:
- A systematic review and meta-analysis evaluated the diagnostic accuracy of preoperative arthroscopic tissue cultures.
- Included studies compared arthroscopic cultures with tissue biopsies from revision surgery, joint aspiration, and serum inflammatory markers.
- Searched MEDLINE, Embase, and Cochrane Central databases for relevant studies.
Key Points:
- Seven studies met inclusion criteria, analyzing various shoulder arthroplasty types.
- Arthroscopic tissue cultures demonstrated high sensitivity (0.76) and specificity (0.91).
- Arthroscopic cultures were significantly more accurate than joint aspiration and inflammatory marker testing (ESR/CRP).
Conclusions:
- Preoperative arthroscopic tissue cultures accurately predict intraoperative findings in shoulder arthroplasty infections.
- Arthroscopy offers superior diagnostic accuracy compared to conventional aspiration and inflammatory marker tests.
- Arthroscopic tissue cultures represent a valuable emerging tool for managing shoulder PJI.
