Validity of preoperative ultrasound-guided aspiration in the revision of hip prosthesis.
Preoperative diagnosis of septic loosening hip prosthesis is often challenging. Culture test on joint samples obtained during revision surgery is the diagnostic gold standard while the role of preoperative hip aspiration is still controversial. The aims of this prospective randomized study were to compare the sensitivity, specificity and accuracy of preoperative ultrasound-guided and fluoroscopic-guided aspiration, and to identify associated laboratory parameters or scintigraphy that could help in predicting septic loosing hip prosthesis. Sixty patients affected by persistent pain after hip prosthesis randomly received fluoroscopic-guided or ultrasound-guided hip aspiration before revision surgery. The results of culture tests of joint fluid presurgically and at surgery were compared. In addition, associated blood inflammatory markers and scintigraphy were evaluated. Ultrasound-guided aspiration showed a better sensitivity (69% vs. 27%), specificity (94% vs. 75%) and accuracy (83% vs. 40%) than fluoroscopic-guided aspiration. The combination of ultrasound-guided aspiration and C-reactive protein represents the best model to predict septic loosening hip prosthesis preoperatively.
Service of Ecography and Radiology, Rizzoli Orthopaedic Institute, Bologna, Italy. milva.battaglia@ior.it
Milva
M
Battaglia
Francesca
F
Vannini
Federica
F
Guaraldi
Giuseppe
G
Rossi
Federico
F
Biondi
Alessandra
A
Sudanese
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044963:Biopsy, Fine-Needle / Q000379:methods*; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D007593:Joint Instability / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000209:etiology*; D012086:Reoperation / Q000379:methods; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000379:methods*; D055815:Young Adult