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During a two-stage revision for prosthetic joint infections (PJI), joint aspirations, open tissue sampling and serum inflammatory markers are performed before re-implantation to exclude ongoing silent infection. We investigated the performance of these diagnostic procedures on the risk of recurrence of PJI among asymptomatic patients undergoing a t...
Contexts in source publication
Context 1
... 12 cases (12/62, 19%), PJI recurred after reimplanta- tion with a mean and median delay of 218 and 88 days, respectively (Table 1). All PJI were surgical site infections without evidence for haematogenous origin. ...
Context 2
... sampling before re-implantation A total of 19 invasive diagnostic procedures were performed in 18 patients before re-implantation (18/62, 29%) including 18 joint aspiration procedures (median 33 days before re- implantation, range 0-205 days) and one open biopsy (126 days before). No iatrogenic complications were observed as a result of these invasive procedures (Table 1). ...
Context 3
... all but one case, the samples were free of leucocytes and staining failed to reveal pathogens. The only exception was a recurrent PJI due to S. aureus (last case of Table 1). This case was also the only one revealing clinical pus at the operation site among all study patients (1/62; 1.6%). ...
Context 4
... landmark publication of Zimmerli et al. cites that at least three intraoperative tissue specimens should be sampled for culture [1], which is common practice, although some experts ideally recommend up to six specimens [17]. In our study population, the average number of intraoperative microbiologic samples was 3.3, and only a quarter of all reimplantations revealed less than three samples (Table 1). Therefore we equally exclude a major sampling bias. ...
Citations
... Swabs have a low sensitivity and should be avoided [11]. Microorganisms isolated from sinus tracts usually represent the microbial colonization of skin, rather than the pathogen of infection, so culture of the sinus tract should be avoided [17,18]. ...
A significant number of prosthetic joint infections (PJI) are culture‐negative and/or misinterpreted as aseptic failures in spite of the correct implementation of diagnostic culture techniques, such as tissue sample processing in a bead mill, prolonged incubation time, or sonication of removed implants. Misinterpretation may lead to unnecessary surgery and needless antimicrobial treatment. The diagnostic value of non‐culture techniques has been investigated in synovial fluid, periprosthetic tissues, and sonication fluid. Different feasible improvements, such as real‐time technology, automated systems and commercial kits are now available to support microbiologists. In this review, we describe non‐culture techniques based on nucleic acid amplification and sequencing methods. Polymerase chain reaction (PCR) is a frequently used technique in most microbiology laboratories which allows the detection of a nucleic acid fragment by sequence amplification. Different PCR types can be used to diagnose PJI, each one requiring the selection of appropriate primers. Henceforward, thanks to the reduced cost of sequencing and the availability of next‐generation sequencing (NGS), it will be possible to identify the whole pathogen genome sequence and, additionally, to detect all the pathogen sequences present in the joint. Although these new techniques have proved helpful, strict conditions need to be observed in order to detect fastidious microorganisms and rule out contaminants. Specialized microbiologists should assist clinicians in interpreting the result of the analyses at interdisciplinary meetings. New technologies will gradually be made available to improve the etiologic diagnoses of PJI, which will remain an important cornerstone of treatment. Strong collaboration among all specialists involved is essential for the correct diagnosis of PJI.
... Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) are essential serological markers in the diagnosis of PJI. However, ESR and CRP values can be normal in cases where PJI is caused by a low-virulence organism [4,5]. Therefore, the use of more accessible biomarkers would improve efficiency and accuracy in the diagnosis of PJI, especially if they exhibit good diagnostic performance in chronic and low-virulence infections. ...
Background
Fibrinogen (Fbg) and D-dimer have been used as biomarkers for the diagnosis of periprosthetic joint infection (PJI). However, previous research has reported conflicting results on the diagnostic value of D-dimer in comparison to Fbg, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR).
Aim
This study aimed to: (1) determine the optimal threshold of plasma Fbg and D-dimer in the diagnosis of PJI and compare their diagnostic value to that of CRP and ESR; and (2) investigate whether Fbg and D-dimer perform differently than CRP and ESR as diagnostic indicators for different types of PJI.
Methods
A total of 115 revision cases after total hip arthroplasty (THA) and total knee arthroplasty (TKA) were identified. Based on demographic characteristics, 25 culture-positive cases were matched to 50 culture-negative cases using propensity score matching. Sensitivity, specificity, receiver operating characteristics (ROC), negative predictive value (NPV), and positive predictive value (PPV) were calculated and compared.
Results
The optimal thresholds were 2.72 mg/L for D-dimer, 3.655 g/L for Fbg, 12.64 mg/L for CRP, and 27 mm/h for ESR. Levels of plasma Fbg, D-dimer, CRP, and ESR were significantly higher in the culture-positive group than the culture-negative group. Fbg, D-dimer, CRP, and ESR showed sensitivity of 0.92, 0.56, 0.92, and 0.88, respectively, and showed specificity of 0.84, 0.96, 0.94, and 0.80, respectively. The ROC curve showed that CRP has the highest area under the curve (AUC) (0.94), followed by Fbg (0.90), ESR (0.87), and D-dimer (0.81).
Conclusions
Plasma Fbg exhibited a similar diagnostic performance compared to CRP and ESR in predicting culture-positive results in PJI. Plasma D-dimer showed high specificity but low sensitivity. In our study, Fbg and D-dimer did not show better diagnostic performance with different pathogens and different types of PJI. Further studies are required to investigate the difference between serum D-dimer and plasma D-dimer in the arthroplasty population.
... Indeed, the disappearance of clinical signs and the normalization of serum biomarkers do not accurately identify patients at the lowest risk of infection recurrence [16,17,20,32,33]. Moreover, joint aspiration before definitive reimplantation and intraoperative bacterial sampling at the time of reimplantation predict successful procedures with low levels of accuracy when cutoffs suggested at the time of diagnosis are adopted [9,28,31]. Three meta-analyses that evaluated the predictive value of different tests to guide the appropriate timing of reimplantation concluded that no single diagnostic test could definitively confirm that patients are free of PJI after the first stage and before reimplantation [10,14,21]. Therefore, multiple diagnostic tests are often used to determine risk of infection persistence or recurrence before reimplantation, but none of the tests is sufficiently accurate to exclude persistence or recurrence of infection after reimplantation. ...
Background:
Although synovial fluid can be used to diagnose periprosthetic joint infections (PJI) effectively, only the cutoff values adopted at the time of PJI diagnosis have been standardized, and few data are currently available about effectiveness of synovial fluid examination before definitive reimplantation.
Questions/purposes:
We asked: (1) What are the most appropriate thresholds for synovial fluid leukocyte counts (WBC) and neutrophil percentage (PMN percentage) in a patient group undergoing definitive reimplantation after an uninterrupted course of antibiotic therapy for chronic PJI? (2) What is the predictive value of our synovial WBC and PMN percentage threshold compared with previously proposed thresholds?
Methods:
In all, 101 patients with PJI were evaluated for inclusion from January 2016 to December 2018. Nineteen percent (19 of 101) of patients were excluded because of the presence of a chronic inflammatory disease, acute/late hematogenous infection, low amount of synovial fluid for laboratory investigations or infection persistence after spacer placement, and adequate antibiotic therapy. Finally, 81% (82 of 101) of patients with a median (range) age of 74 years (48 to 92) undergoing two-stage revision for chronic TKA infection, who were followed up at our institution for a period 96 weeks or more, were included in this study. The patients did not discontinue antibiotic treatment before reimplantation and were treated for 15 days after reimplantation if intraoperative cultures were negative. No patient remained on suppressive treatment after reimplantation. Synovial fluid was aspirated aseptically with a knee spacer in place to evaluate the cell counts before reimplantation. Thirteen percent (11 of 82) of patients had persistent or recurrent infection, defined as continually elevated erythrocyte sedimentation rate or C-reactive protein levels coupled with local signs and symptoms or positive cultures. The synovial fluid WBC counts and PMN percentage from the 11 patients with persistent or recurrent PJI were compared with the 71 patients who were believed to be free of PJI. Receiver operating characteristic (ROC) curve analyses assessed the predictive value of the parameters, and the areas under the curves (AUCs) were evaluated. The sensitivities, specificities, and positive and negative predictive values were determined for the WBC count and PMN percentage. Patients with persistent or recurrent infection had higher median WBC counts (471 cells/µL versus 1344 cells/µL; p < 0.001) and PMN percentage (36% versus 61%; p < 0.001) than did patients believed to be free of PJI.
Results:
ROC curve analysis identified the best threshold values to be a WBC count of 934 cells/µL or more (sensitivity 0.82 [95% CI 0.71 to 0.89], specificity 0.82 [95% CI 0.71 to 0.89]) as well as a PMN percentage of at least 52% (sensitivity 0.82 [95% CI 0.71 to 0.89] and specificity 0.78 [95% CI 0.67 to 0.86]. We found no difference between the AUCs for the WBC count and the PMN percentage (0.87 [95% CI 0.79 to 0.96] versus 0.84 [95% CI 0.73 to 0.95]. Comparing the sensitivities and specificities of the synovial fluid WBC count and PMN percentage proposed by other authors, we find that a PMN percentage more than 52% showed better predictive value than previously reported.
Conclusion:
Based on our findings, we believe that patients with WBC counts of at least 934 and PMN percentage of 52% or more should not undergo reimplantation but rather a repeat debridement, as their risk of persistent or recurrent PJI appears prohibitively high. The accuracy of the proposed cutoffs is better than previously reported.
Level of evidence:
Level III, diagnostic study.
... Erythrocyte sedimentation rate(ESR) and C-reactive protein(CRP) are essential serological markers in the diagnostic process. However, ESR and CRP can be normal in cases where PJI is caused by low-virulence organism [4,5].Therefore, novel biomarkers that are easily accessible would improve e ciency and accuracy in the diagnosis of PJI, especially if they exhibit good diagnostic performance in chronic and low-virulence infections. ...
Background: Fibrinogen(Fbg) and D-dimer were introduced as biomarkers for the diagnosis of PJI. However, previous researches have reported controversial outcome on the diagnostic value of D-dimer in comparison to Fbg, CRP and ESR.
Aim: This study aims to: 1.Determine the optimal threshold of plasma Fbg and D-dimer in the diagnosis of PJI and compare their diagnostic value to that of CRP and ESR. 2.Investigate if Fbg and D-dimer performs differently than CRP and ESR in different types of PJI.
Methods: 115 revision cases after total hip arthroplasty(THA) and total knee arthroplasty(TKA) were identified. 30 PJI cases were matched to 60 Aseptic cases based on demographic characteristics using propensity score matching. Sensitivity, Specificity, Receiver operating characteristics(ROC), Negative predictive value(NPV) and Positive predictive value(PPV) were calculated and compared.
Results: The optimal threshold is 1.69 mg/L for D-dimer and 3.655g/L for Fbg. Plasma Fbg, D-dimer, CRP and ESR were significantly higher in the PJI group than the Aseptic group. Fbg, D-dimer, CRP and ESR showed sensitivity of 0.83, 0.67, 0.83 and 0.8 respectively and showed specificity of 0.87, 0.77, 0.92 and 0.82 respectively. ROC curve showed that CRP has the highest AUC(0.90), followed by Fbg(0.89), ESR(0.88) and D-dimer(0.77).
Conclusion: Plasma Fbg exhibited similar diagnostic performance comparing to CRP and ESR. Plasma D-dimer is of limited diagnostic value. In our study, Fbg and D-dimer did not show better diagnostic performance in any subtypes of PJI. Further studies are required to investigate the difference between serum D-dimer and plasma D-dimer in arthroplasty population.
... The treatment of PJI is based on systemic antibiotic therapy combined with different surgical strategies: irrigation and debridement, one-stage replacement and two-stage replacement. Depending on the series consulted, the success rates for each of these procedures vary between 10% and 75% for irrigation and debridement [4,5], 86% and 100% for one-stage replacement [6,7], and between 65% and 100% in two-stage replacement [8,9]. Thus, PJI is considered a pathology of increasing incidence whose therapeutic strategies can be defined as unsatisfactory. ...
Introduction
Periprosthetic infection is considered an increasing incidence pathology whose therapeutic strategies can be defined as unsatisfactory. Currently, animal models are employed to study its physiopathology and strategic therapies, but non-species-specific materials are implanted as foreign bodies. The use of these implants implies intrinsic instability, which hinders the development of a biofilm on their surfaces and complicates the post-operative recovery of the animal. The objective of the present study is the design of a species-specific implant for the New Zealand white (NZW) rabbit by means of 3D printing.
Materials and methods
A CT scan of the knee of a NZW rabbit was performed, and the tibial surface was reconstructed in order to fabricate a species-specific tibial plateau using Horos® and Autodesk® Meshmixer™ software. This implant was inserted in fifteen NZW rabbits, and the assessment of its stability was based on the position of the limb at rest and the animal weight-bearing capacity. Biofilm formation on the surface was demonstrated by crystal violet staining.
Results
A 1.81 cm × 1 cm × 1.24 cm stainless steel implant was designed. It consisted of a 4-mm-thick tibial plate with a rough surface and an eccentric metaphyseal anchoring. All of the animals exhibited hyperflexion of the operated limb immediately post-operative, and 100% could apply full weight bearing from day 5 after surgery.
Conclusions
The species-specific design of implants in experimental surgery encourages rapid recovery of the animal and the development of a biofilm on their surfaces, making them ideal for the study of the physiopathology and for establishing possible therapeutic targets for prosthetic infection.
... stage protocol is that infection is supposedly cured when reimplantation is done. Infection eradication can be evaluated by different diagnostic methods: serological markers [1 -6], scintigraphy [4], preoperative aspiration [5, 7], or intraoperative histology of frozen samples [8]. Despite these tests, some ...
... The patients analyzed in the present series present a high number of samples (up to eight in the most recent cases) and always have bone and synovium samples, as well as sonication results. Other studies include articular fluid and synovial membrane [9], tissue and sonication [11,12], only sonication [13], swabs from tissues [5] or cement [10]. Perhaps in the future bacterial 16s RNA detection [21] may become standard. ...
... Published results are limited to reporting recurrence in patients with positive cultures. Some papers report a low risk of infection recurrence, from 0% to 9% [9 -11, 24], while others report a very high risk, 24% [5], 50% [12], or up to 63% [13]. This high variability may be explained by the different treatments applied to these patients. ...
Background
The main reason for using a two-stage exchange in Prosthetic Joint Infection (PJI) is that bacteria are completely eradicated in reimplantation surgery. However, reports of a positive culture in the second surgery are growing. The number of positive intraoperative cultures and their influence on final results is not well-established.
Objectives
To compare epidemiological characteristics, infection recurrence and clinical evolution of patients with only one vs. at least two positive cultures based on our series of cases with positive cultures in reimplantation surgery.
Material and Methods
Retrospective study of 55 patients was conducted prospectively. They were diagnosed with chronic PJI, treated with a two-stage protocol and at least three intraoperative cultures were obtained in the second stage. These cultures were negative in 28 patients. Fourteen patients showed two or more cultures with the same microorganism and they were denominated patients with positive cultures. Thirteen patients showed only one positive culture, and they were considered contaminated. Both groups of patients (positive cultures and contaminated ones) received the second cycle of oral antibiotics for 6 months. Functional results were evaluated with the Harris Hip Score (hips) or Knee Society Clinical Rating Score (KSCRS) (knees).
Results
There were no significant differences between patients with positive or contaminated cultures for age (p=0.420) and sex (p=0.385). The knee was involved in 13/14 positive and in only 6/13 contaminated patients (p=0.013). Staphylococcus epidermidis was the predominant isolate, but there were differences between positive (methicillin-resistant in 7/14 patients) and contaminated cultures (methicillin-sensitive in 6/13). There were no differences in the prevalence of polymicrobial cultures (p=0.785) or coincidence with cultures from the first stage (p=0.257). Three infection recurrences have appeared in patients with positive cultures (3/13, 21%) and none in patients with contaminated cultures. There are no differences in HSS or KSCRS when comparing final functional results between groups (p=0.411).
Conclusion
The prevalence of positive cultures in reimplantation surgery is higher than expected (25%), and more frequent in women and in knee arthroplasties. The most frequently involved microorganism is Staphylococcus epidermidis , but antibiotic sensitivity varies between patients with positive cultures (methicillin-resistant) and those with contaminated cultures (methicillin-sensitive). There were no infection recurrences in patients with contaminated cultures, but those with positive cultures present a risk of over 20%.
... In this respect, rapid microbiological detection, preferably within a couple of hours, is mandatory. So far, Gram staining has shown a poor sensitivity (~30%) in diagnosing PJI, and therefore, it clinical utility appears to be low [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. However, most of the performed studies have been conducted in revision surgeries comprising mostly chronic PJIs. ...
... Sensitivity was significantly higher in patients with a high CRP, probably due to a higher bacterial inoculum. Although the sensitivity of Gram staining was moderate, it was significantly higher in our study compared to previous reports (Table 1) [6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23]. To illustrate, a meta-analysis conducted by Ouyang et al. including a total of 4647 patients, demonstrated an overall sensitivity of Gram staining of merely 19%. ...
Introduction: Staphylococcus aureus is an independent risk factor for DAIR failure in patients with a late acute prosthetic joint infection (PJI). Therefore, identifying the causative microorganism in an acute setting may help to decide if revision surgery should be chosen as a first surgical approach in patients with additional risk factors for DAIR failure. The aim of our study was to determine the sensitivity of Gram staining in late acute S. aureus PJI.
Material and methods: We retrospectively evaluated all consecutive patients between 2005-2015 who were diagnosed with late acute PJI due to S. aureus. Late acute PJI was defined as the development of acute symptoms and signs of PJI, at least three months after the index surgery. Symptoms existing for more than three weeks were excluded from the analysis. Gram staining was evaluated solely for synovial fluid.
Results: A total of 52 cases were included in the analysis. Gram staining was positive with Gram positive cocci in clusters in 31 cases (59.6%). Patients with a C-reactive protein (CRP) > 150 mg/L at clinical presentation had a significantly higher rate of a positive Gram stain (30/39, 77%) compared to patients with a CRP ≤ 150 mg/L (4/10, 40%) (p=0.02). A positive Gram stain was not related to a higher failure rate (60.6% versus 57.9%, p 0.85).
Conclusion: Gram staining may be a useful diagnostic tool in late acute PJI to identify S. aureus PJI. Whether a positive Gram stain should lead to revision surgery instead of DAIR should be determined per individual case.
... Clinical signs of infection (swelling, erythema, fever, positive scintigraphy and macroscopic signs of infection during surgery such as pus) or elevated conventional biomarkers like CRP and leukocytes might be falsely positive or negative. Interpretation of positive microbiological cultures from samples taken prior to or during surgery is often difficult because infections of orthopaedic implants are frequently associated with low numbers of microorganism and it is often not possible to cultivate bacteria 29,30 . It is impossible to identify the pathogen responsible for sepsis in up to 50% of patients 31 . ...
The early and accurate diagnosis of periprosthetic joint infection (PJI) can be challenging. Fibrinogen plays an important role in mediating inflammation of bacterial infections and therefore could be a valuable biomarker for PJI. The purpose of this study was to investigate the sensitivity and specificity of serum levels of fibrinogen in detecting PJI, and to compare the results with the established PJI biomarkers C-reactive protein (CRP) and leukocyte count. Eighty-four patients (124 surgeries) were prospectively included. The preoperatively analyzed parameters were fibrinogen, CRP and leukocyte count. The sensitivity and specificity of the biomarkers were calculated and compared. Fibrinogen (p < 0.001), CRP (p < 0.001) and leukocyte count (p < 0.001) had a statistically significant correlation with the criteria defining the presence of PJI. For fibrinogen, the value of 519 mg/dl had a sensitivity of 0.90 and a specificity of 0.34. The CRP cut-off point of 11.00 mg/dl had a sensitivity of 0.90 and a specificity of 0.74. The leukocyte count of 5.68 G/l had a sensitivity of 0.90 and a specificity of 0.39. Our results indicated that fibrinogen is a significant biomarker for detecting a bacterial PJI. It has shown to be a cost-efficient diagnostic support with high sensitivity and specificity.
... Thus, Synovasure TM may deserve a role for ruling out infection within a few minutes in complex situations. In recurrent infections, the sensitivity, specificity, NPV, and PPV of microbiological studies are decreased and novel diagnostic tools are therefore of considerable interest [17][18][19]. Given that the diagnosis of infection relies on a converging set of arguments, the largest possible number of tools must be available, most notably in complex cases. ...
Background:
Joint aspiration is currently the reference standard test for diagnosing periprosthetic joint infection (PJI) despite the high rate of false-negative results, of which a major cause is the fastidious nature of some micro-organisms. A rapid diagnostic test that detects alpha defensin (Synovasure™, Zimmer, Warsaw, IN, USA) in joint fluid can provide the diagnosis of PJI within a few minutes across the full spectrum of causative organisms (including mycobacteria and yeasts). Its performance in detecting bacterial infections is unaltered by concomitant antibiotic therapy. Few studies of Synovasure™ have been conducted by groups that were involved in designing the test, which has not been validated in France. Assessments in referral centres where complex microbiological situations are common hold considerable interest. The objective of this prospective study was to determine the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and causes of error of Synovasure™ used to diagnose periprosthetic infection in complex microbiological situations.
Hypothesis:
The rapid diagnostic test Synovasure™ has greater than 90% NPV for detecting periprosthetic infections in complex microbiological infections.
Material and methods:
Synovasure™ was used 42 times in 39 patients between October 2015 and October 2017 in challenging microbiological situations (discordant joint aspiration results (n=20), negative cultures with clinical or laboratory evidence of infection, (n=21), and concomitant antibiotic therapy (n=1)). Of the 39 patients, 23 had total knee prostheses, 13 total hip prostheses, and 3 total femoral prostheses. The reference standard to which the Synovasure™ results were compared was the PJI criteria set developed by the Musculoskeletal Infection Society (MSIS).
Results:
Synovasure™ was negative in 30 cases with negative joint fluid cultures (30/42, 71.4%). Of the 12 (28.6%) cases with positive Synovasure™ results, only 7 (7/12, 58.3%) had positive joint fluid cultures. According to the MSIS criteria 9 cases were infected, including 8 with positive and 1 with negative Synovasure™ results. Of the 33 cases that were not infected according to MSIS criteria, 29 had negative and 3 positive Synovasure™ results; the remaining case had a positive Synovasure™ result but was excluded when metallosis was found intra-operatively. NPV was 96.7%, PPV 72.7%, sensitivity 88.9%, and specificity 90.6%.
Discussion:
The high NPV of SynovasureTMsuggests a role for this test in microbiologically complex situations as a new tool for ruling in and, most importantly, ruling out infection in doubtful cases.
Level of evidence:
III, prospective study of diagnostic accuracy.
... Recent published diagnostic and treatment algorithms included diagnostic joint aspiration, serum inflammatory markers, intraoperative cultures, and pathologic specimens [1,26]. Nevertheless, especially, diagnostic joint aspiration and serum inflammatory markers have been discussed controversial in recent publications [6,15,20,25,26,30,35]. ...
... Thus, the presumptive diagnosis has a major impact on therapy pathway. The relevance of preoperative diagnostic tools Table 1 The like diagnostic joint aspiration and serum inflammatory markers has been queried in recent literature [6,30]. Hence, a tool with a higher specificity and sensibility especially to diagnose low-grade PJI is desirable. ...
... In addition, the existing algorithms are often based on preoperative joint aspiration and serum inflammatory markers as main diagnostic tools [3,8,26,31]. In recent studies, the relevance of the latter parameters was questioned [6,20,30]. For CRP, a sensitivity of 0.17 and a specificity of 0.81 were published for a cut-off value 1.0 mg/dl and respective values of 0.48 and 0.61 for a cut-off value 0.5 mg/dl, alike to the values of the present study [6,30]. ...
IntroductionThe diagnostic algorithm in cases of assumed low-grade infection after total knee arthroplasty is discussed controversial. The aim of this study was to evaluate the reliability of neosynovium biopsies via knee arthroscopies in predicting a periprosthetic knee joint infection (PJI). Methods
From 2010 to 2015, 56 consecutive patients received a diagnostic arthroscopy of the knee joint by reason of an assumed PJI. In 34 cases, a revision arthroplasty was performed after the diagnostic arthroscopy. The microbiologic and histologic results from neosynovium biopsies were compared to intraoperative findings of the consecutively performed revision arthroplasty. ResultsThe arthroscopic neosynovium biopsies had a sensitivity of 0.88 (0.47–1.0 95 % confidence interval), a specificity of 0.88 (0.7–0.98), a positive predictive value of 0.7 (0.35–0.93), and a negative predictive value of 0.96 (0.79–1.0). The accuracy was 0.88. We determined a higher sensitivity of neosynovium biopsies compared to C-reactive protein (p = 0.038) and white blood cell count (p < 0.001) in serum. The itemized evaluation of histologic results showed a significant higher sensitivity compared to microbiologic results (p = 0.045) and a higher accuracy. Conclusions
The analysis of arthroscopic neosynovium biopsies can be helpful to verify or exclude a PJI in selected patients. Especially, histologic assessment showed a high accordance with final results.Level of evidence IV, retrospective study.
