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Clinical Orthopaedics and Related Research®

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01-03-2013 | Clinical Research

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

Authors: Bernd Fink, MD, Alexander Gebhard, MD, Martin Fuerst, MD, Irina Berger, MD, Peter Schäfer, MD

Published in: Clinical Orthopaedics and Related Research® | Issue 3/2013

Abstract

Background

The role of the synovial biopsy in the preoperative diagnosis of a periprosthetic joint infection (PJI) of the hip has not been clearly defined.

Questions/purposes

We asked whether the value of a biopsy for a PJI is greater than that of aspiration and C-reactive protein (CRP).

Methods

Before revision in 100 hip endoprostheses, we obtained CRP values, aspirated the joint, and obtained five synovial biopsy samples for bacteriologic analysis and five for histologic analysis. Microbiologic and histologic analyses of the periprosthetic tissue during revision surgery were used to verify the results of the preoperative diagnostic methods. The minimum followup was 24 months (median 32; range, 24–47 months).

Results

Forty-five of the 100 prostheses were identified as infected. The biopsy, with a combination of the bacteriologic and histologic examinations, showed the greatest diagnostic value of all the diagnostic procedures and led to a sensitivity of 82% (95% CI, ± 11%), specificity of 98% (95% CI, ± 4%), positive predictive value of 97% (95% CI, ± 5%), negative predictive value of 87% (95% CI, ± 8.3%), and accuracy of 91%.

Conclusions

The biopsy technique has a greater value than aspiration and CRP in the diagnosis of PJI of the hip (Masri et al. J Arthroplasty 22:72–78, 2007). In patients with a negative aspirate, but increased CRP or clinical signs of infection, we regard biopsy to be preferable to just repeating the aspiration.

Level of Evidence

Level II prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

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Title: High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip
Authors: Bernd Fink, MD
Alexander Gebhard, MD
Martin Fuerst, MD
Irina Berger, MD
Peter Schäfer, MD
Publication date: 01-03-2013
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 3/2013
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-012-2474-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

High Diagnostic Value of Synovial Biopsy in Periprosthetic Joint Infection of the Hip

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Questions/purposes

Methods

Results

Conclusions

Level of Evidence

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