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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Diagnostic Accuracy of Arthroscopic Pre-Revision Tissue Biopsy in Shoulder Arthroplasty
Collin N Nguyen1, Jack H Drake1, Mark M Mounajjed2
1University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA; Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
Background:
The diagnosis of periprosthetic joint infection (PJI) following shoulder arthroplasty remains challenging. Serum lab markers and joint aspirations demonstrate limited sensitivity and specificity in this setting. Arthroscopic pre-revision tissue biopsy (PTB) may improve organism-level diagnosis prior to revision surgery.
Methods:
A retrospective review of consecutive patients who underwent an arthroscopic PTB from a single center from 2018-2025 was conducted. PTB was performed prior to revision surgery at the discretion of the attending surgeon to aid in the diagnosis of possible PJI and inform decision-making pertaining to revision surgery. Diagnostic performance, including sensitivity, specificity, and positive predictive value, and negative predictive value of arthroscopic PTB for diagnosing PJI were calculated using intraoperative cultures at the time of ultimate revision as the gold standard based on the 2018 International Consensus Meeting on Musculoskeletal Infection (ICM) PJI Criteria.
Results:
Twenty-three patients met the inclusion criteria, with eleven (47.8%) meeting criteria for PJI according to the 2018 ICM criteria. When using either ≥2 concordant positive cultures at the time of revision or ICM criteria as the reference standard, PTB demonstrated poor sensitivity (30.0% [95% CI, 6.7-65.3%] and 27.3% [95% CI 6-61%], respectively) and low negative predictive value (65.0% [95% CI, 55.3-73.6%] and 60%, [95% CI 51.1-68.3%] respectively). In total, three patients who had all negative cultures at the time of PTB eventually demonstrated ≥2 unexpected positive cultures at revision. Clinically, these findings suggest that a negative PTB result should not be used in isolation to support implant retention or to defer revision surgery when clinical suspicion for infection persists.
Conclusion:
Pre-revision tissue biopsy demonstrated poor sensitivity and NPV in the detection of PJI. Negative PTB findings did not exclude infection, and results should be taken into context with other clinical and laboratory data. Future research should focus on determining if there are patient-specific factors or clinical scenarios in which PTB may be beneficial.
Level Of Evidence:
III, Retrospective Case Control Design, Diagnostic Study.