关节置换术后感染翻修术前关节液抽吸培养的诊断价值较低。
Low Diagnostic Value of Synovial Aspiration Culture Prior to Reimplantation in Periprosthetic Joint Infection.
机构信息
Trauma Department, Hannover Medical School (MHH), Hannover, Germany
Trauma Department, Hannover Medical School (MHH), Hannover, Germany.
出版信息
In Vivo. 2021 Jul-Aug;35(4):2409-2416. doi: 10.21873/invivo.12518.
BACKGROUND/AIM: We aimed to determine the diagnostic value of the synovial aspiration culture prior to reimplantation in two- (or more) stage exchange of periprosthetic joint infection.
PATIENTS AND METHODS
This was a retrospective study, spanning over ten years including all synovial cultures of patients with two- (or more) stage exchange due to periprosthetic joint infection.
RESULTS
A total of 183 patients were included, mean age was 66.6 years (range=12.8-93.4 years). Overall sensitivity of synovial aspiration cultures before reimplantation was 56.6%, specificity 84.6%, negative predictive value (NPV) 63.8%, positive predictive value (PPV) 80.2%, area under the curve (AUC) 70.6%. Sensitivity of the knee in comparison to the hip culture was significantly higher, as well as the NPV and the AUC (p=0.038). In case of complete removal of prosthesis, the sensitivity and AUC were significantly reduced, whereas the specificity was comparable with prosthesis in situ, partial removal or complete removal.
CONCLUSION
Due to the low sensitivity, obtaining several synovial cultures in the prosthesis-free interval to exclude persistence of infection, does not seem reasonable.
背景/目的：我们旨在确定在二期（或更多期）关节置换感染翻修术前关节抽吸培养的诊断价值。
患者与方法
这是一项回顾性研究，跨越十年，包括所有因假体周围关节感染行二期（或更多期）关节置换的患者的关节抽吸培养。
结果
共纳入 183 例患者，平均年龄 66.6 岁（范围 12.8-93.4 岁）。术前关节抽吸培养的总体敏感性为 56.6%，特异性为 84.6%，阴性预测值为 63.8%，阳性预测值为 80.2%，曲线下面积（AUC）为 70.6%。与髋关节培养相比，膝关节培养的敏感性、NPV 和 AUC 更高（p=0.038）。完全取出假体时，敏感性和 AUC 显著降低，而特异性与假体原位、部分取出或完全取出时相似。
结论
由于敏感性较低，在假体取出间隙中获取多个关节抽吸培养以排除感染持续存在似乎不合理。
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