Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection
<p>Abstract</p> <p>Background</p> <p>The correct diagnosis of a prosthetic joint infection (PJI) is crucial for adequate surgical treatment. The detection may be a challenge since presentation and preoperative tests are not always obvious and precise. This prospective s...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2008-07-01
|
| Series: | Journal of Orthopaedic Surgery and Research |
| Online Access: | http://www.josr-online.com/content/3/1/31 |
| _version_ | 1828354690165768192 |
|---|---|
| author | Perka Carsten Strube Patrick Hasart Olaf Morawietz Lars Müller Michael Tohtz Stephan |
| author_facet | Perka Carsten Strube Patrick Hasart Olaf Morawietz Lars Müller Michael Tohtz Stephan |
| author_sort | Perka Carsten |
| collection | DOAJ |
| description | <p>Abstract</p> <p>Background</p> <p>The correct diagnosis of a prosthetic joint infection (PJI) is crucial for adequate surgical treatment. The detection may be a challenge since presentation and preoperative tests are not always obvious and precise. This prospective study was performed to evaluate a variety of pre- and intraoperative investigations. Furthermore a detailed evaluation of concordance of each preoperative diagnosis was performed, together with a final diagnosis to assess the accuracy of the pre-operative assumption of PJI.</p> <p>Methods</p> <p>Between 01/2005 and 02/2007, a prospective analysis was performed in 50 patients, who had a two stage revision because of assumed PJI. Based on clinical presentation, radiography, haematological screening, or early failure, infection was assumed and a joint aspiration was performed. Depending upon these findings, a two stage revision was performed, with intra-operative samples for culture and histological evaluation obtained. Final diagnosis of infection was based upon the interpretation of the clinical presentation and the pre- and intraoperative findings.</p> <p>Results</p> <p>In 37 patients a positive diagnosis of PJI could be made definitely. The histopathology yielded the highest accuracy (0.94) in identification of PJI and identified 35 of 37 infections (sensitivity 0.94, specificity 0.94, positive-/negative predictive value 0.97/0.86). Intra-operative cultures revealed sensitivities, specificities, positive-/negative predictive values and accuracy of 0.78, 0.92, 0.96, 0.63 and 0.82. These values for blood screening tests were 0.95, 0.62, 0.88, 0.80, and 0.86 respectively for the level of C-reactive protein, and 0.14, 0.92, 0.83, 0.29 and, 0.34 respectively for the white blood-cell count. The results of aspiration were 0.57, 0.5, 0.78, 0.29, and 0.54.</p> <p>Conclusion</p> <p>The detection of PJI is still a challenge in clinical practice. The histopathological evaluation emerges as a highly practical diagnostic tool in detection of PJI. Furthermore, we found a discrepancy between the pre-operative suspicion of PJI and the final post-operative diagnosis, resulting in a slight uncertainty in whether loosening is due to bacterial infection or not. The variation in accuracy of the single tests may influence the detection of PJI. Level of Evidence: Diagnostic Level I.</p> |
| first_indexed | 2024-04-14T02:28:58Z |
| format | Article |
| id | doaj.art-8059cdc4fc1343fdae912789a69afb21 |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T02:28:58Z |
| publishDate | 2008-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-8059cdc4fc1343fdae912789a69afb212022-12-22T02:17:47ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2008-07-01313110.1186/1749-799X-3-31Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infectionPerka CarstenStrube PatrickHasart OlafMorawietz LarsMüller MichaelTohtz Stephan<p>Abstract</p> <p>Background</p> <p>The correct diagnosis of a prosthetic joint infection (PJI) is crucial for adequate surgical treatment. The detection may be a challenge since presentation and preoperative tests are not always obvious and precise. This prospective study was performed to evaluate a variety of pre- and intraoperative investigations. Furthermore a detailed evaluation of concordance of each preoperative diagnosis was performed, together with a final diagnosis to assess the accuracy of the pre-operative assumption of PJI.</p> <p>Methods</p> <p>Between 01/2005 and 02/2007, a prospective analysis was performed in 50 patients, who had a two stage revision because of assumed PJI. Based on clinical presentation, radiography, haematological screening, or early failure, infection was assumed and a joint aspiration was performed. Depending upon these findings, a two stage revision was performed, with intra-operative samples for culture and histological evaluation obtained. Final diagnosis of infection was based upon the interpretation of the clinical presentation and the pre- and intraoperative findings.</p> <p>Results</p> <p>In 37 patients a positive diagnosis of PJI could be made definitely. The histopathology yielded the highest accuracy (0.94) in identification of PJI and identified 35 of 37 infections (sensitivity 0.94, specificity 0.94, positive-/negative predictive value 0.97/0.86). Intra-operative cultures revealed sensitivities, specificities, positive-/negative predictive values and accuracy of 0.78, 0.92, 0.96, 0.63 and 0.82. These values for blood screening tests were 0.95, 0.62, 0.88, 0.80, and 0.86 respectively for the level of C-reactive protein, and 0.14, 0.92, 0.83, 0.29 and, 0.34 respectively for the white blood-cell count. The results of aspiration were 0.57, 0.5, 0.78, 0.29, and 0.54.</p> <p>Conclusion</p> <p>The detection of PJI is still a challenge in clinical practice. The histopathological evaluation emerges as a highly practical diagnostic tool in detection of PJI. Furthermore, we found a discrepancy between the pre-operative suspicion of PJI and the final post-operative diagnosis, resulting in a slight uncertainty in whether loosening is due to bacterial infection or not. The variation in accuracy of the single tests may influence the detection of PJI. Level of Evidence: Diagnostic Level I.</p>http://www.josr-online.com/content/3/1/31 |
| spellingShingle | Perka Carsten Strube Patrick Hasart Olaf Morawietz Lars Müller Michael Tohtz Stephan Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection Journal of Orthopaedic Surgery and Research |
| title | Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection |
| title_full | Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection |
| title_fullStr | Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection |
| title_full_unstemmed | Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection |
| title_short | Diagnosis of periprosthetic infection following total hip arthroplasty – evaluation of the diagnostic values of pre- and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection |
| title_sort | diagnosis of periprosthetic infection following total hip arthroplasty evaluation of the diagnostic values of pre and intraoperative parameters and the associated strategy to preoperatively select patients with a high probability of joint infection |
| url | http://www.josr-online.com/content/3/1/31 |
| work_keys_str_mv | AT perkacarsten diagnosisofperiprostheticinfectionfollowingtotalhiparthroplastyevaluationofthediagnosticvaluesofpreandintraoperativeparametersandtheassociatedstrategytopreoperativelyselectpatientswithahighprobabilityofjointinfection AT strubepatrick diagnosisofperiprostheticinfectionfollowingtotalhiparthroplastyevaluationofthediagnosticvaluesofpreandintraoperativeparametersandtheassociatedstrategytopreoperativelyselectpatientswithahighprobabilityofjointinfection AT hasartolaf diagnosisofperiprostheticinfectionfollowingtotalhiparthroplastyevaluationofthediagnosticvaluesofpreandintraoperativeparametersandtheassociatedstrategytopreoperativelyselectpatientswithahighprobabilityofjointinfection AT morawietzlars diagnosisofperiprostheticinfectionfollowingtotalhiparthroplastyevaluationofthediagnosticvaluesofpreandintraoperativeparametersandtheassociatedstrategytopreoperativelyselectpatientswithahighprobabilityofjointinfection AT mullermichael diagnosisofperiprostheticinfectionfollowingtotalhiparthroplastyevaluationofthediagnosticvaluesofpreandintraoperativeparametersandtheassociatedstrategytopreoperativelyselectpatientswithahighprobabilityofjointinfection AT tohtzstephan diagnosisofperiprostheticinfectionfollowingtotalhiparthroplastyevaluationofthediagnosticvaluesofpreandintraoperativeparametersandtheassociatedstrategytopreoperativelyselectpatientswithahighprobabilityofjointinfection |