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Low accuracy in preoperative tissue biopsies for diagnosing chronic periprosthetic joint infection: an observational
Hannah Eriksson1, Stergios Lazarinis1
1Department of Surgical Sciences/Orthopaedics, Uppsala University Hospital, Uppsala, Sweden.
Objective:
Diagnosing periprosthetic joint infection (PJI) can be challenging. The ability to distinguish between septic and aseptic failure of a joint prosthesis is crucial for treatment strategy optimisation and prognosis prediction. Preoperative tissue cultures are included in many diagnostic algorithms; however, studies report different degrees of concordance (63%-85%) with intraoperative cultures. This study aimed to investigate the diagnostic performance of tissue biopsies in the preoperative diagnostic process with the 2018 International Consensus Meeting criteria as a reference and to describe the concordance between microbiological findings in pre- and intraoperative biopsies.
Methods:
This observational retrospective study included 44 patients requiring revision surgery of a total hip or knee arthroplasty, where the diagnostic workup included biopsies of periprosthetic tissue. The accuracy of preoperative biopsies was calculated, and concordance between microbiological findings in pre- and intraoperative biopsies was described.
Results:
The accuracy was 59%, with a sensitivity of 50% and specificity of 79%. Full concordance between microbiological findings in pre- and intraoperative biopsies was found in 64% of the cases.
Conclusion:
An open biopsy of periprosthetic tissue cannot reliably confirm or exclude PJI, and, therefore, should not be performed.
Insights
Preoperative tissue biopsies for diagnosing periprosthetic joint infection (PJI) are unreliable. This study found open biopsies should not be performed due to low accuracy in confirming or excluding PJI.
Area of Science:
- Orthopedic surgery
- Infectious disease diagnostics
- Arthroplasty revision
Background:
- Diagnosing periprosthetic joint infection (PJI) is critical for treatment and prognosis.
- Preoperative tissue cultures are used but have variable concordance with intraoperative findings (63%-85%).
- Distinguishing septic from aseptic prosthesis failure remains a clinical challenge.
Purpose of the Study:
- To evaluate the diagnostic performance of preoperative tissue biopsies for PJI.
- To assess concordance between preoperative and intraoperative microbiological findings.
- To determine if preoperative biopsies align with the 2018 International Consensus Meeting criteria.
Main Methods:
- Observational retrospective study of 44 patients undergoing hip or knee arthroplasty revision.
- Analysis of periprosthetic tissue biopsies for microbiological assessment.
- Calculation of biopsy accuracy, sensitivity, and specificity.
Main Results:
- Preoperative biopsies showed 59% accuracy, 50% sensitivity, and 79% specificity for PJI.
- Full concordance between pre- and intraoperative biopsy results was observed in 64% of cases.
- Findings indicate limited diagnostic value of preoperative biopsies.
Conclusions:
- Open biopsies of periprosthetic tissue lack reliability in confirming or excluding PJI.
- The diagnostic performance suggests preoperative biopsies should not be routinely performed.
- Further research may be needed to refine PJI diagnostic strategies.
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