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Review
. 2022 Dec 13;7(6):259-267.
doi: 10.5194/jbji-7-259-2022. eCollection 2022.

The concordance between preoperative synovial fluid culture and intraoperative tissue cultures in periprosthetic joint infection: a systematic review

Thomas J A van Schaik  1   2 , Lex D de Jong  1 , Maurits P A van Meer  3 , Jon H M Goosen  4 , Matthijs P Somford  1
Affiliations
Review

The concordance between preoperative synovial fluid culture and intraoperative tissue cultures in periprosthetic joint infection: a systematic review

Thomas J A van Schaik et al. J Bone Jt Infect. .

Abstract

Background: this systematic review aims to evaluate the concordance between preoperative synovial fluid culture and intraoperative tissue cultures in patients with periprosthetic joint infection (PJI) undergoing total hip (THA) or knee arthroplasty (TKA) revision surgery. Methods: this review was conducted in accordance with the preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA) statement. Cochrane, Embase, PubMed, and Web of Science databases were searched to identify studies involving patients who had THA or TKA revision surgery for PJI and for whom preoperative synovial fluid culture and intraoperative tissue cultures were performed. Studies were only included if the diagnosis of PJI was based on the EBJIS (the European Bone and Joint Infection Society) or MSIS (Musculoskeletal Infection Society) criteria. Risk of bias was assessed using an amended version of Joanna Briggs Institute's (JBI) critical appraisal checklist for case series. Results: seven studies were included in this review comprising 1677 patients. All studies had a retrospective study design and five studies explored patients undergoing revision surgery of THA or TKA. Concordance rates varied between 52 % and 79 %, but different authors defined and calculated concordance differently. Six studies were judged as having an unclear to high risk of bias and one study as having a low risk of bias. Conclusions: the included studies showed a wide range of concordance rates between preoperative synovial fluid culture and intraoperative tissue cultures and the majority of studies had a high risk of bias. Higher-quality studies are warranted to obtain a more accurate estimate of this concordance rate. We recommend continuing the use of a system such as the EBJIS definition or MSIS criteria when diagnosing PJI.

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Conflict of interest statement

The contact author has declared that none of the authors has any competing interests.

Figures

Figure 1
Figure 1
PRISMA flow diagram of literature search and screening process.
Figure 2
Figure 2
Risk of bias summary: review authors' judgments about risk of bias items for each included study; –  =  high risk of bias; ?  =  unclear risk of bias; +   =  low risk of bias.
Figure 3
Figure 3
Risk of bias graph: review authors' judgments about risk of bias items, presented as percentages across the seven studies appraised with JBI's critical appraisal checklist for case series. JBI: Joanna Briggs Institute; PJI: periprosthetic joint infection.
See this image and copyright information in PMC

References

    1. Ahmad SS, Shaker A, Saffarini M, Chen AF, Hirschmann MT, Kohl S. Accuracy of diagnostic tests for prosthetic joint infection: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2016;24:3064–3074. doi: 10.1007/S00167-016-4230-Y. - DOI - PubMed
    1. American Academy of Orthopaedic Surgeons Diagnosis and Prevention of Periprosthetic Joint Infections Evidence-Based Clinical Practice Guideline. [last access: 10 December 2022]. 2019. https://www.aaos.org/pjicpg.
    1. Atkins BL, Athanasou N, Deeks J, Crook DWM, Simpson H, Peto T, Mclardy-Smith P, Berendt AR, Benson M, Carr A, Collopy D, Cooke P, Kenwright J, McClardy-Smith P, Simpson H, de Steiger R, Gundle R, Willett K, Atkins B, Berendt A, Bowler I, Conlon C, Crook D, Emptage A, Athanasou N. Prospective evaluation of criteria for microbiological diagnosis of prosthetic-joint infection at revision arthroplasty. The OSIRIS Collaborative Study Group. J Clin Microbiol. 1998;36:2932–2939. doi: 10.1128/JCM.36.10.2932-2939.1998. - DOI - PMC - PubMed
    1. Boyle KK, Kapadia M, Chiu YF, Khilnani T, Miller AO, Henry MW, Lyman S, Carli AV. The James A. Rand Young Investigator's Award: Are Intraoperative Cultures Necessary If the Aspiration Culture Is Positive? A Concordance Study in Periprosthetic Joint Infection. J Arthroplasty. 2021;36:S4–S10. doi: 10.1016/j.arth.2021.01.073. - DOI - PubMed
    1. Christensen TH, Ong J, Lin D, Aggarwal VK, Schwarzkopf R, Rozell JC. How Does a “Dry Tap” Impact the Accuracy of Preoperative Aspiration Results in Predicting Chronic Periprosthetic Joint Infection? J Arthroplasty. 2022;37:925–929. doi: 10.1016/j.arth.2022.01.066. - DOI - PubMed