Diagnosing periprosthetic hip joint low-grade infection via arthroscopic neo synovium biopsies.
BACKGROUND
There is currently a lack of consensus regarding the most effective diagnostic algorithm for cases of supposed low-grade infection after total hip arthoplasty (THA).


OBJECTIVE
The aim of this study was to assess reliability in the use of biopsies, obtained by hip arthroscopy, to detect a periprosthetic hip joint infection (PJI).


METHODS
From 2012 to 2016, diagnostic arthroscopy of the hip joint was performed in 20 patients with a supposed PJI following THA. In 10 of these patients, the THA was revised for various reasons after diagnostic arthroscopy. The microbiological and histological findings of the biopsies obtained by arthroscopy were compared to findings from intraoperative samples of the revision arthroplasty.


RESULTS
For arthroscopic biopsies, we detected a sensitivity of 1.00 (95% confidence interval [CI] 0.40-1.00), a specificity of 0.83 (95% CI 0.36-1.00), a positive predictive value of 0.80 (95% CI 0.28-1.00), and a negative predictive value of 1.00 (95% CI 0.48-1.00). The accuracy was 0.90.


CONCLUSIONS
The analysis of arthroscopic biopsies represents a helpful tool to verify or rule out a PJI in selected patients. Nevertheless, minimally invasive diagnostic tools (e.g., laboratory analysis and aspiration) should be utilized beforehand.
['Claassen|Leif|L|', 'Wirries|Nils|N|', 'Ettinger|Sarah|S|', 'Pastor|Marc-Frederic|MF|', 'Windhagen|Henning|H|', 'Flörkemeier|Thilo|T|']
D000368:Aged D000369:Aged, 80 and over D000465:Algorithms D019644:Arthroplasty, Replacement, Hip D001182:Arthroscopy D001706:Biopsy D003937:Diagnosis, Differential D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D016459:Prosthesis-Related Infections D012086:Reoperation D012680:Sensitivity and Specificity D013583:Synovial Membrane
hip joint low-grade infection Arthroscopy revision arthroplasty periprosthetic joint infection synovial biopsy