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Aspiration arthrography of the hip joint. Its uses and limitations in revision hip surgery
D M Mulcahy1, G C Fenelon, D P McInerney
1Adelaide Hospital, Dublin, Ireland.
Abstract:
Seventy-one patients undergoing revision hip surgery over a 5-year period from 1988 to 1993 had aspiration arthrography of the hip as a preoperative investigation. Sixteen hips were found to be infected at operation. Preoperative aspiration yielded positive cultures in 11 of these 16 hips. There was identical correlation between the organisms isolated on aspiration and during surgery. There were 5 false positive cultures from the aspirates of the remaining 55 noninfected hips. All of the hips from which a true positive culture was obtained had either clinical or radiologic evidence suggestive of infection. Aspiration arthrography does not have a major role to play as a routine investigation prior to all revision hip surgery. It is recommended that its use be reserved for those hips in which there is either clinical, hematologic, or radiologic evidence of infection.
Insights
Preoperative hip aspiration arthrography can help identify infection before revision hip surgery. Reserve this test for patients with suspected infection based on clinical, blood, or imaging results.
Area of Science:
- Orthopedics
- Infectious Diseases
- Diagnostic Imaging
Background:
- Revision hip surgery carries a risk of periprosthetic joint infection (PJI).
- Accurate preoperative diagnosis of PJI is crucial for effective surgical planning and patient outcomes.
Purpose of the Study:
- To evaluate the diagnostic accuracy of aspiration arthrography in detecting hip joint infection before revision hip surgery.
- To determine the utility of aspiration arthrography as a routine preoperative investigation.
Main Methods:
- A retrospective review of 71 patients undergoing revision hip surgery between 1988 and 1993.
- Aspiration arthrography was performed preoperatively.
- Intraoperative findings and microbiological cultures were compared with aspiration results.
Main Results:
- Of 16 infected hips, aspiration cultures were positive in 11 (69%).
- Organisms isolated from aspiration correlated identically with intraoperative cultures.
- Five false-positive results occurred in non-infected hips; these all had suggestive clinical or radiographic signs.
- True positive cultures were only found in hips with existing clinical or radiographic evidence of infection.
Conclusions:
- Aspiration arthrography is not recommended as a routine investigation for all revision hip surgeries.
- Its use should be limited to cases with clinical, hematologic, or radiographic suspicion of infection.
- This targeted approach optimizes resource utilization and diagnostic yield for suspected PJI.
