Is ultrasound-guided hip aspiration more successful than fluoroscopic-guided aspiration in diagnosing prosthetic joint infection?
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Published:2023-05-09
Issue:3
Volume:8
Page:151-163
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ISSN:2206-3552
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Container-title:Journal of Bone and Joint Infection
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language:en
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Short-container-title:J. Bone Joint Infect.
Author:
Treu Emily A.ORCID, Cushman Daniel M.ORCID, Wheelwright John C., Blackburn Brenna E., Teramoto Masaru, Archibeck Michael J.ORCID
Abstract
Abstract. Introduction: aspiration of total hip arthroplasty (THA) is
commonly performed to assist in the diagnosis of prosthetic joint infection
(PJI). This study aimed to determine whether fluoroscopic- or ultrasound-
guided hip aspiration differs in the ability to acquire synovial fluid and
in the accuracy of diagnosing infection.
Methods: all THA aspirations performed between 2014 and 2021 at
our institution were retrospectively identified. Aspirations were classified
as successful or dry. If successful, the volume of fluid obtained was
recorded. The sensitivity and specificity of hip aspiration in identifying
PJI were calculated with four methods: (1) culture results excluding saline lavage, (2) culture results including saline lavage, (3) 2018 Musculoskeletal Infection Society (MSIS) International Consensus Meeting (ICM) criteria, and (4) 2021 European Bone and Joint Infection Society (EBJIS) criteria. Analyses were performed using
Student's t test or Wilcoxon rank sum for continuous variables and
chi-squared or Fisher's exact test for categorical variables.
Results: 290 aspirations were included (155 fluoroscopic-guided and
135 ultrasound-guided). Success of aspiration (>0.5 mL) was more
common in the ultrasound cohort (69 %) than fluoroscopy (53 %)
(p<0.0055). When successful, more volume was obtained in the
ultrasound cohort (mean 13.1 mL vs. 10.0 mL; p=0.0002).
Ultrasound-guided aspiration was more sensitive than fluoroscopy in
diagnosing PJI using culture results excluding saline lavage (85 % vs.
73 %; p=0.03), culture results including saline lavage (85 % vs.
69 %; p=0.001), 2018 MSIS-ICM criteria (77 % vs. 52 %; p=0.02), and
2021 EBJIS criteria (87 % vs. 65 %; p=0.02). Ultrasound-guided
aspiration was more specific than fluoroscopy in diagnosing PJI using 2021
EBJIS criteria (100 % vs. 96 %; p=0.001).
Conclusions: ultrasound-guided aspiration is more frequently
successful and yields more fluid than fluoroscopic-guided aspiration of THA.
Ultrasound-guided aspiration is more sensitive in diagnosing PJI than
fluoroscopy using culture data, 2018 MSIS-ICM criteria, and 2021 EBJIS
criteria.
Publisher
Copernicus GmbH
Subject
Infectious Diseases,Orthopedics and Sports Medicine,Surgery
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