Should all hip and knee prosthetic joints be aspirated prior to revision surgery?

Aims It is essential to exclude a periprosthetic joint infection (PJI) prior to revision surgery. It is recommended to routinely aspirate the joint before surgery. However, this may not be necessary in a subgroup of patients. The aim of our study was to investigate if specific clinical and implant c...

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Bibliographic Details
Published in:Archives of orthopaedic and trauma surgery 2021-03, Vol.141 (3), p.461-468
Main Authors: Staphorst, Femke, Jutte, Paul C., Boerboom, Alexander L., Kampinga, Greetje A., Ploegmakers, Joris J. W., Wouthuyzen-Bakker, Marjan
Format: Article
Language:English
Subjects:
Infections
Knee Revision Surgery
Medicine
Medicine & Public Health
Orthopedics
Prostheses
Surgery
Transplants & implants
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Summary:Aims It is essential to exclude a periprosthetic joint infection (PJI) prior to revision surgery. It is recommended to routinely aspirate the joint before surgery. However, this may not be necessary in a subgroup of patients. The aim of our study was to investigate if specific clinical and implant characteristics could be identified to rule out a PJI prior to revision surgery. Methods We retrospectively evaluated clinical and implant characteristics of patients who underwent a hip or knee revision surgery between October 2015 and October 2018. Patients were diagnosed with a PJI according to the MSIS diagnostic criteria. Results A total of 156 patients were analyzed, including 107 implants that were revised because of prosthetic loosening and 49 because of mechanical failure (i.e. instability, malalignment or malpositioning). No PJI was diagnosed in the group with mechanical failure. In the prosthetic loosening group, 20 of 107 were diagnosed with a PJI (19%). Although there was a significantly lower chance of having a PJI with an implant age of > 5 years combined with a CRP 
ISSN:0936-8051
1434-3916
DOI:10.1007/s00402-021-03791-6