Validation of Synovial Aspiration in Girdlestone Hips for Detection of Infection Persistence in Patients Undergoing 2-Stage Revision Total Hip Arthroplasty

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Abstract

Background

The aim of this study was to assess the diagnostic performance of synovial aspiration in Girdlestone hips, without a Polymethylmethacrylate (PMMA) spacer, for the detection of infection persistence before total hip arthroplasty (THA) reimplantation.

Methods

Seventy-four patients undergoing stage revision THA surgery were included in this retrospective cohort study. Both synovial cultures and serum C-reactive protein values were acquired before explantation of the THA and of the Girdlestone hip before reimplantation.

Results

The diagnostic performance of the synovial aspiration of the Girdlestone hip achieved a sensitivity of only 13% and a specificity of 98%. The determination of the serum C-reactive protein value for Girdlestone hips achieved a sensitivity of 95% and a specificity of only 20%.

Conclusions

Our data show that the Girdlestone aspiration can neither reliably confirm nor exclude a persistence of infection.

Section snippets

Materials and Methods

Seventy-four patients undergoing a stage revision THA surgery between 2006 and 2013 fulfilled the inclusion criteria and were included in this retrospective cohort study. The patient collective was comprised of 38 men and 36 women with an average age of 66.7 years (27-87 years). Inclusion criteria were a stage revision THA without the use of a PMMA spacer, including a synovial aspiration, and determination of the serum C-reactive protein (CRP) value both before the explantation and before the

Results

All of the 69 included patients in our study had a preoperative suspicion of PJI, through clinical presentation such as a sinus tract or positive bacterial growth in a preoperative synovial aspiration, leading to a stage revision THA therapy. From these 69 patients, 66 met our strict criteria for PJI through the intraoperative samples acquired during the THA explantation procedure. The patients who did not fulfill our criteria for PJI all had positive preoperative synovial aspirations, whereas

Discussion

The synovial aspiration of a Girdlestone resection arthroplasty is performed to detect a persistence of PJI and facilitate the clinical decision to proceed or delay the endoprosthetic reimplantation. Multiple studies have shown that the synovial aspiration of both THA hips and hips with an in situ PMMA spacer underlies a large variance for the detection of PJI; however, there are little data to assess the performance of synovial aspiration in true Girdlestone hips 4., 6.. Our data show that the

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No author associated with this paper has disclosed any potential or pertinent conflicts which may be perceived to have impending conflict with this work. For full disclosure statements refer to http://dx.doi.org/10.1016/j.arth.2015.09.053.

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