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. 2018 Jan 10;13(1):7.
doi: 10.1186/s13018-017-0703-z.

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Sebastian Philipp Boelch  1 , Manuel Weissenberger  2 , Frederik Spohn  2 , Maximilian Rudert  2 , Martin Luedemann  2
Affiliations

Insufficient sensitivity of joint aspiration during the two-stage exchange of the hip with spacers

Sebastian Philipp Boelch et al. J Orthop Surg Res. .

Abstract

Background: Evaluation of infection persistence during the two-stage exchange of the hip is challenging. Joint aspiration before reconstruction is supposed to rule out infection persistence. Sensitivity and specificity of synovial fluid culture and synovial leucocyte count for detecting infection persistence during the two-stage exchange of the hip were evaluated.

Methods: Ninety-two aspirations before planned joint reconstruction during the two-stage exchange with spacers of the hip were retrospectively analyzed.

Results: The sensitivity and specificity of synovial fluid culture was 4.6 and 94.3%. The sensitivity and specificity of synovial leucocyte count at a cut-off value of 2000 cells/μl was 25.0 and 96.9%. C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) values were significantly higher before prosthesis removal and reconstruction or spacer exchange (p = 0.00; p = 0.013 and p = 0.039; p = 0.002) in the infection persistence group. Receiver operating characteristic area under the curve values before prosthesis removal and reconstruction or spacer exchange for ESR were lower (0.516 and 0.635) than for CRP (0.720 and 0.671).

Conclusions: Synovial fluid culture and leucocyte count cannot rule out infection persistence during the two-stage exchange of the hip.

Keywords: Hip; Joint aspiration; Periprosthetic infection; Spacer; Two-stage exchange.

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Conflict of interest statement

Authors’ information

Not applicable

Ethics approval and consent to participate

Ethics approval was confirmed by the Ethics Commission of the Medical Faculty of the University of Wuerzburg, Germany (Reference number 2016072801). Patient’s consent to participate was not required in this retrospective study.

Consent for publication

Not applicable

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of synovial fluid culture categorized by infection eradication and infection persistence: 92 cases of two-stage exchange with a spacer were analyzed. We found 22 cases with persistent infection, defined by intraoperative samples for culture and histopathologic examination or intraoperatively evident pus. In the group of infection persistence, one culture was positive and 21 were negative at interstage aspiration. In the group of 70 cases with infection eradication, 4 cultures yielded growth and 66 did not at interstage aspiration
Fig. 2
Fig. 2
Flow chart of synovial fluid count categorized by infection eradication and infection persistence: 40 cases of two-stage exchange with a spacer were analyzed. We found 8 cases with persistent infection, defined by intraoperative samples for culture and histopathologic examination or intraoperatively evident pus. In the group of infection persistence, synovial leucocyte count was ≥ 2000/μl in 2 and < 2000/μl in 6 interstage aspirations. In the group of 32 cases with infection eradication, synovial leucocyte count was ≥ 2000/μl in one and < 2000/μl in 31 interstage aspirations
Fig. 3
Fig. 3
Box plots of CRP values before prosthesis removal (PR) and reconstruction or spacer exchange (ROS) categorized by infection eradication and infection persistence
See this image and copyright information in PMC

References

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