Pre-operative biopsies in the revision setting - helpful or harmful?

Area of Science:

• Orthopedic Surgery
• Infectious Disease Diagnostics

Background:

• Consensus is lacking on routine pre-operative biopsies for presumed aseptic revision shoulder and elbow cases.
• Surgical practice for infection confirmation in these cases varies widely.

Purpose of the Study:

• To evaluate the utility and accuracy of pre-revision biopsies in identifying infection in presumed aseptic shoulder and elbow revision surgery.
• To assess the impact of pre-revision biopsies and antibiotic treatment on intra-operative findings and outcomes.

Main Methods:

• A retrospective review of 81 patients undergoing revision shoulder or elbow procedures over four years.
• Analysis of pre-operative biopsy results, intra-operative findings, and clinical outcomes using electronic patient records.

Main Results:

• Seven of 40 patients (17.5%) with pre-revision biopsies had positive results, with infection cleared in 4/7 cases post-antibiotics.
• Six cases initially negative for infection were found to be infected at revision.
• 13 of 41 patients (31.7%) without pre-revision biopsies were found to have infection at the time of revision.

Conclusions:

• Pre-revision biopsies demonstrate low sensitivity (54%) for detecting bacterial infection in presumed aseptic cases.
• The procedure carries a risk of introducing infection and pre-revision antibiotics may not guarantee negative biopsies.