Comparative Diagnostic Accuracy of Image-Guided Aspiration Techniques for Periprosthetic Hip Infection: A Systematic...

Image-guided fluid aspiration is a key component in the diagnostic work-up of suspected prosthetic joint infection of the hip (PJI). Fluoroscopy, ultrasound (US), and computed tomography (CT) are frequently employed to guide aspiration; however, comparative evidence regarding their diagnostic performance and procedural outcomes remains limited. This study aimed to evaluate and compare the diagnostic accuracy and technical performance of these modalities.

A systematic review was conducted in accordance with PRISMA guidelines. PubMed, Embase, and CINAHL were searched for studies evaluating fluoroscopy-, US-, or CT-guided hip aspiration to aid PJI diagnosis. Outcomes of interest included diagnostic performance, dry tap rates, and procedural characteristics. Dry tap rates were pooled by modality using random-effects meta-analysis of proportions. Due to heterogeneity in reference standards, diagnostic accuracy outcomes were synthesised narratively.

Ten studies comprising 1,574 hip aspirations were included (647 fluoroscopy, 831 US, 96 CT). Sensitivity ranged from 0.52-0.89 for US and 0.27-0.83 for fluoroscopy, with consistently high specificity (≥0.75) across modalities. CT-guided aspiration demonstrated sensitivity of 0.67 and specificity of 0.98 in a single study. Pooled dry tap rates were lower for US (17%, 95% CI 4-30%) compared with fluoroscopy (27%, 95% CI 9-45%), with substantial heterogeneity (I²>97%).

Reported specificity is comparable between ultrasound- and fluoroscopy-guided hip aspiration for PJI. Ultrasound-guided aspiration demonstrates higher reported sensitivity and lower dry tap rates, although interpretation is limited by heterogeneity in reference standards.

This review provides a focused synthesis of comparative evidence on imaging modalities for hip aspiration in PJI. It highlights a potential diagnostic and practical advantage of ultrasound-guided aspiration.