The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty
The diagnostic value of routine preliminary biopsy in diagnosing late prosthetic joint infection after hip and knee arthroplasty
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DOI：
10.1302/0301-620x.102b3.bjj-2019-0684.r1
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发表时间：
2020-03-01
影响因子：
4.6
通讯作者：
Schlumherger, M.
中科院分区：
文献类型：
--
作者：
Fink, B.;Schuster, P.;Schlumherger, M.
目的假体周围组织活检是假体关节感染（PJI）的重要诊断工具，因为它可以检测对抗生素敏感的致病微生物。我们的目的是调查在晚期PJI病例中，从术前活检和术中翻修手术中获得的样本之间组织分析中识别出的细菌差异的频率;方法共508例患者需要全髋关节置换术（THA）（n = 231）或全膝关节置换术（TKA）（n = 277）的翻修手术。由于部件松动，在翻修手术前进行了活检。根据肌肉骨骼感染协会（MSIS）的标准，在活检和翻修手术中收集的组织样本进行了分析。ResultsIn总数，178（113 THA，65 TKA）被归类为感染。活检程序的敏感性为93.8%，特异性为97.3%，阳性预测值（PPV）为94.9%，阴性预测值（NPV）为96.7%，准确性为96.1%。在178例感染患者中，26例（14.6%）在活检和翻修手术中检测到的细菌存在差异。这种差异需要改变抗生素治疗，只有两例（1.1%）。结论活检是一个有用的工具，诊断PJI，但可能有一个差异，在检测到的细菌活检和翻修手术。然而，在大多数情况下，这并不影响抗生素治疗的选择，使得这种现象的临床相关性很低。
AimsBiopsy of the periprosthetic tissue is an important diagnostic tool for prosthetic joint infection (PJI) as it enables the detection of the responsible microorganism with its sensitivity to antibiotics. We aimed to investigate how often the bacteria identified in the tissue analysis differed between samples obtained from preoperative biopsy and intraoperative revision surgery in cases of late PJI; and whether there was a therapeutic consequence.MethodsA total of 508 patients who required revision surgery of total hip arthroplasty (THA) (n = 231) or total knee arthroplasty (TKA) (n = 277) because of component loosening underwent biopsy before revision surgery. The tissue samples collected at biopsy and during revision surgery were analyzed according to the criteria of the Musculoskeletal Infection Society (MSIS).ResultsIn total, 178 (113 THA, 65 TKA) were classified as infected. The biopsy procedure had a sensitivity of 93.8%, a specificity of 97.3%, a positive predictive value (PPV) of 94.9%, a negative predictive value (NPV) of 96.7%, and an accuracy of 96.1%. Of the 178 infected patients, 26 showed a difference in the detected bacteria from the biopsy and the revision surgery (14.6%). This difference required a change to antibiotic therapy in only two cases (1.1%).ConclusionBiopsy is a useful tool to diagnose PJI, but there may be a difference in the detected bacteria between the biopsy and revision surgery. However, this did not affect the choice of antibiotic therapy in most cases, rendering the clinical relevance of this phenomenon as low.