title: Pre-operative intra-articular deep tissue sampling with novel retrograde forceps improves the diagnostics in periprosthetic joint infection.
abstract: Histopathological tissue analysis is a key parameter within the diagnostic algorithm for suspected periprosthetic joint infections (PJIs), conventionally acquired in open surgery. In 2014, Hügle and co-workers introduced novel retrograde forceps for retrograde synovial biopsy with simultaneous fluid aspiration of the knee joint. We hypothesised that tissue samples acquired by retrograde synovial biopsy are equal to intra-operatively acquired deep representative tissue samples regarding bacterial detection and differentiation of periprosthetic infectious membranes.
  
  
  
  Thirty patients (male n = 15, 50%; female n = 15, 50%) with 30 suspected PJIs in painful total hip arthroplasties (THAs) were included in this prospective, controlled, non-blinded trial. The results were compared with intra-operatively obtained representative deep tissue samples.
  
  
  
  In summary, 27 out of 30 patients were diagnosed correctly as infected (17/17) or non-infected (10/13). The sensitivity to predict a PJI using the Retroforce® sampling forceps in addition to standard diagnostics was 85%, the specificity 100%.
  
  
  
  Retrograde synovial biopsy is a new and rapid diagnostic procedure under local anaesthesia in patients with painful THAs with similar histological results compared to deep tissue sampling.
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany. wimmer@uni-bonn.de.
authors.forename: Matthias D
authors.initials: MD
authors.lastname: Wimmer
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors.forename: Milena M
authors.initials: MM
authors.lastname: Ploeger
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors.forename: Max J
authors.initials: MJ
authors.lastname: Friedrich
authors.affiliation: Osteoarthritis Research Centre Basel, University Hospital Basel, Basel, Switzerland.
authors.forename: Thomas
authors.initials: T
authors.lastname: Hügle
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors.forename: Sascha
authors.initials: S
authors.lastname: Gravius
authors.affiliation: Department of Orthopaedics and Trauma Surgery, University of Bonn, Bonn, Germany.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Randau
mesh_terms: D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D001706:Biopsy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011300:Preoperative Care; D011446:Prospective Studies; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000382:microbiology / Q000601:surgery; D013525:Surgical Instruments; D013582:Synovial Fluid / Q000382:microbiology; D013583:Synovial Membrane / Q000382:microbiology* / Q000473:pathology
keywords: Biopsy; Deep tissue sampling; Intra-articular; Periprosthetic joint infection; Total hip arthroplasty