Abstract
Background: Total joint arthroplasties continue to increase as do periprosthetic joint infections (PJIs). Ultrasound-guided aspiration can yield useful synovial fluid for analysis while avoiding radiation exposure. This study presents a high-yield, ultrasound-guided technique with analysis of aspiration results. Methods: All consecutive ultrasound-guided aspirations of hip arthroplasties performed from May 2016 through to April 2019 were retrospectively reviewed. Patient demographic information, component specifics, presence of draining sinus, and inflammatory markers were recorded. Results of aspiration including volume, appearance, lavage use, synovial fluid differential leukocyte count, synovial neutrophil percent, and culture results were recorded. Surgical results, specimen cultures, and surgeon description of purulence were recorded. Aspiration results were compared to the surgical specimen results in all patients who underwent reoperations. Results: Review of 349 hip aspirations demonstrated accuracy of 87 %, sensitivity of 83 %, specificity of 89 %, positive predictive value of 79 %, and negative predictive value 91 %. Surgical and aspiration cultures matched in 81 % of cases. Bloody aspirates and aspirates obtained after lavage had less accuracy at 69 % and 60 %, respectively. Specificity was 100 % for cultures obtained with lavage and 91 % for bloody aspirates. Synovial leukocyte count and neutrophil percentage was obtained in 85 % of aspirations, and cultures were obtained in 98 % of aspirates. Contamination rate was 2 %. Conclusion: Ultrasound-guided aspirations aid in the diagnosis of PJI. The use of lavage to obtain fluid is helpful when aspiration cultures are positive. Bloody aspirates are less accurate but have high specificity. A low contamination rate and 88 % accuracy results with this meticulous technique.
Highlights
Total joint arthroplasties continue to increase so that over 600 000 total hip arthroplasties will be performed in the United States annually by 2030 (Kurtz et al, 2007, 2014; Sloan et al, 2018)
The value of the aspiration culture results alone to predict infections was determined by calculating accuracy, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), each with 95 % confidence intervals compared to International Consensus Meeting (ICM) criteria
Bloody aspirates vs. ICM 2018∗ (N = 41)
Summary
Total joint arthroplasties continue to increase so that over 600 000 total hip arthroplasties will be performed in the United States annually by 2030 (Kurtz et al, 2007, 2014; Sloan et al, 2018). Fluid collections in soft tissues may be identified and aspirated (Craig, 2013), which is not feasible with fluoroscopy Another recent study describes using ultrasound guidance to biopsy tissue in suspected infectious hip arthroplasties due to a dry tap rate of 37 % (Sconfienza, 2021). This required use of a Tru-Cut needle with some discordant results. 1. present a high-yield, ultrasound-guided technique for aspirating synovial fluid from hip arthroplasties without need of biopsy and avoidance of dry taps; 2. 3. analyze effects of body mass index (BMI), presence of draining sinus or antibiotic cement, use of saline lavage, and presence of blood on obtained fluid
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