Diagnosis of knee prosthetic joint infection; aspiration and biopsy |
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| Affiliation: | 1. Department of Trauma and Orthopaedics, Exeter Knee Reconstruction Unit, Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter Hospitals, Barrack Road, EX2 5DW, United Kingdom;2. Department of Microbiology, Royal Devon and Exeter Hospitals, Barrack Road, United Kingdom;1. Department of Orthopedic Surgery, Diakonessenhuis Utrecht/Zeist, Utrecht, the Netherlands;2. Clinical Orthopedic Research Center Midden Nederland, Diakonessenhuis Utrecht/Zeist, Zeist, the Netherlands;3. Department of Microbiology and Immunology, Diakonessenhuis Utrecht/Zeist, Utrecht, the Netherlands;4. Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), University Utrecht, Utrecht, the Netherlands;5. University Medical Center Utrecht (UMCU), Utrecht, the Netherlands;1. Department of Reconstructive Surgery of Osteo-articular Infections, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy;2. ASST Ovest Milanese, UOC Ortopedia e Traumatologia, Ospedale di Legnano, Milan, Italy;3. Hip Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy;4. Knee Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy;5. IRCCS Istituto Ortopedico Galeazzi, Laboratory of Clinical Chemistry and Microbiology, Milan, Italy;1. Departments of Orthopaedic Surgery, University of Arkansas for Medical Sciences, Little Rock, AR;2. Departments of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, AR;1. Rothman Orthopaedic Institute at Thomas Jefferson University, Philadelphia, PA;2. Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel;3. Rush University Medical Center, Chicago, IL;4. Cleveland Clinic, Cleveland, OH |
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| Abstract: | BackgroundProsthetic joint infection (PJI) is a significant cause of morbidity and mortality following knee replacement surgery. The diagnosis can be challenging and is based on a combination of clinical suspicion, radiographic findings and also biochemical/ microbiological investigations. Our Aim was to review the role of aspiration and biopsy in the diagnosis of PJI in Total Knee Arthroplasty (TKA).Method/resultsAspirated synovial fluid should be analysed by direct culture, via blood culture bottles, EDTA bottles for cell count and ‘point of care’ testing such as leucocyte esterase or alpha defensin. Synovial WCC and PMN cell percentage are important steps in diagnosis of both acute and chronic PJI. A minimum of 5 deep samples using a 5 clean instrument technique should be obtained and sent for tissue culture done either blind or arthroscopic. Formal fluoroscopic guided interface biopsy has also been described with excellent results. In a recent series of 86 TKRs preoperative arthroscopic biopsy group had a sensitivity of 100%, specificity of 94.7%, positive predictive value of 87.4% and a negative predictive value of 100%.ConclusionIn the presence of clinical suspicion with raised biomarkers, it is recommended that aspiration +/- biopsy with synovial fluid testing is performed. Direct culture and cell count are recommended. ‘Point of care tests’ such as Leucocyte Esterase testing should be considered. Duration of culture, including pathogen and host factors, should be discussed with a local microbiology/ID department in the context of a formal multi-disciplinary team. |
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| Keywords: | Diagnosis Prosthetic joint infection Total knee arthroplasty Biopsy aspiration |
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