Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

Marcel Niemann; Ellen Otto; Karl F Braun; Frank Graef; Sufian S Ahmad; Sebastian Hardt; Ulrich Stöckle; Andrej Trampuz; Sebastian Meller

doi:10.3390/jcm11102730

Microbiological Advantages of Open Incisional Biopsies for the Diagnosis of Suspected Periprosthetic Joint Infections

J Clin Med. 2022 May 12;11(10):2730. doi: 10.3390/jcm11102730.

Authors

Marcel Niemann^{1

2}, Ellen Otto^{1

2}, Karl F Braun^{1

3}, Frank Graef¹, Sufian S Ahmad^{1

4}, Sebastian Hardt¹, Ulrich Stöckle¹, Andrej Trampuz¹, Sebastian Meller¹

Affiliations

¹ Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, 13353 Berlin, Germany.
² Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration, Berlin Institute of Health at Charité-Universitätsmedizin Berlin, 13353 Berlin, Germany.
³ Department of Trauma Surgery, University Hospital Rechts der Isar, Technical University of Munich, 80333 Munich, Germany.
⁴ Department of Orthopedic Surgery, Hannover Medical School, 30625 Hannover, Germany.

Abstract

Background: Periprosthetic joint infection (PJI) represents a serious complication following total hip (THA) and knee arthroplasty (TKA). When preoperative synovial fluid cultures remain inconclusive, open incisional joint biopsy (OIB) can support causative microorganism identification.

Objective: This study investigates the potential benefit of OIB in THA and TKA patients with suspected PJI and ambigious diagnostic results following synovial fluid aspiration.

Methods: We retrospectively assessed all patients treated from 2016 to 2020 with suspected PJI. Comparing the microbiology of OIB and the following revision surgery, we calculated sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the number needed to treat (NNT).

Results: We examined the diagnostic validity of OIB in 38 patients (20 female) with a median age of 66.5 years. In THA patients (n = 10), sensitivity was 75%, specificity was 66.67%, PPV was 60%, NPV was 80%, and NNT was 2.5. In TKA patients (n = 28), sensitivity was 62.5%, specificity was 95.24%, PPV was 83.33%, NPV was 86.96%, and NNT was 1.42.

Conclusions: Our results indicate that OIB represents an adequate diagnostic tool when previously assessed microbiological results remain inconclusive. Particularly in TKA patients, OIB showed an exceptionally high specificity, PPV, and NPV, whereas the predictive validity of the diagnosis of PJI in THA patients remained low.

Keywords: diagnostics; individual medicine; microbiology; periprosthetic joint infection; total hip arthroplasty; total knee arthroplasty.

Grants and funding

We acknowledge support from the German Research Foundation (DFG) and the Open Access Publication Fund of Charité—Universitätsmedizin Berlin (grant number 433849769).