Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection

Abstract The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the u...

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Autores principales:	Jan Schwarze, Burkhard Moellenbeck, Georg Gosheger, Tom Schmidt-Braekling, Lukas Lampe, Sebastian Klingebiel, Thomas Ackmann, Christoph Theil
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/1fe0db4c329c49f59279c804c455197b
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spelling	oai:doaj.org-article:1fe0db4c329c49f59279c804c455197b2021-12-02T16:53:01ZPoor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection10.1038/s41598-021-90475-12045-2322https://doaj.org/article/1fe0db4c329c49f59279c804c455197b2021-05-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-90475-1https://doaj.org/toc/2045-2322Abstract The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the usefulness of biopsies in patients with inconclusive diagnostic findings. We retrospectively identified 63 patients who underwent incisional biopsy for chronic PJI in the operation theatre following TKA revision between 2010 and 2018 after inconclusive preoperative diagnostics for PJI. In all cases, 5 independent biopsies were taken. Results from open biopsy for PJI were analyzed for diagnostic accuracy using the intraoperative results from following revision surgery as gold standard. 27 patients (43%) had a positive culture taken during biopsy. 15 cases (24%) met the diagnostic criteria for a chronic PJI. Most common organisms were Coagulase-negative staphylococci (67%) and Cutibacterium acnes (30%). Compared to the findings during revision surgery, biopsies showed a sensitivity of 47% and a specificity of 77% for PJI. Open incisional biopsy following inconclusive serum- and synovial diagnostics for low grade PJI may be considered for identification of microorganisms. Due to its low sensitivity and moderate specificity found in the present cohort, microbiological analysis should be combined with additional diagnostic markers and histological investigation. Level of Evidence. Retrospective cohort study (Level III).Jan SchwarzeBurkhard MoellenbeckGeorg GoshegerTom Schmidt-BraeklingLukas LampeSebastian KlingebielThomas AckmannChristoph TheilNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-7 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jan Schwarze Burkhard Moellenbeck Georg Gosheger Tom Schmidt-Braekling Lukas Lampe Sebastian Klingebiel Thomas Ackmann Christoph Theil Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection
description	Abstract The accurate preoperative diagnosis of periprosthetic joint infection (PJI) of total knee arthroplasty (TKA) can be difficult despite the use of a combination of serum and synovial markers. In such inconclusive cases, incisional open biopsy might be considered. This study investigates the usefulness of biopsies in patients with inconclusive diagnostic findings. We retrospectively identified 63 patients who underwent incisional biopsy for chronic PJI in the operation theatre following TKA revision between 2010 and 2018 after inconclusive preoperative diagnostics for PJI. In all cases, 5 independent biopsies were taken. Results from open biopsy for PJI were analyzed for diagnostic accuracy using the intraoperative results from following revision surgery as gold standard. 27 patients (43%) had a positive culture taken during biopsy. 15 cases (24%) met the diagnostic criteria for a chronic PJI. Most common organisms were Coagulase-negative staphylococci (67%) and Cutibacterium acnes (30%). Compared to the findings during revision surgery, biopsies showed a sensitivity of 47% and a specificity of 77% for PJI. Open incisional biopsy following inconclusive serum- and synovial diagnostics for low grade PJI may be considered for identification of microorganisms. Due to its low sensitivity and moderate specificity found in the present cohort, microbiological analysis should be combined with additional diagnostic markers and histological investigation. Level of Evidence. Retrospective cohort study (Level III).
format	article
author	Jan Schwarze Burkhard Moellenbeck Georg Gosheger Tom Schmidt-Braekling Lukas Lampe Sebastian Klingebiel Thomas Ackmann Christoph Theil
author_facet	Jan Schwarze Burkhard Moellenbeck Georg Gosheger Tom Schmidt-Braekling Lukas Lampe Sebastian Klingebiel Thomas Ackmann Christoph Theil
author_sort	Jan Schwarze
title	Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection
title_short	Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection
title_full	Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection
title_fullStr	Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection
title_full_unstemmed	Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection
title_sort	poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/1fe0db4c329c49f59279c804c455197b
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Poor performance of open incisional biopsy for the microbiological diagnosis of periprosthetic knee joint infection

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