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C-0695 - Diagnostic yield of ultrasound guided synovial biopsy in chronic prosthetic joint infection of total knee joint replacements.

L. Wing, A. C. Macdonald, K. Partington; Oxford/UK Type: Scientific Exhibit
Area of Interest: Musculoskeletal joint
Imaging Technique: Ultrasound
Procedure: Biopsy
Special Focus: Infection
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Aims and objectives: Chronic prosthetic joint infection (cPJI) is a rare but clinically important complication of total knee joint replacement (TKJR) which causes loss of function and has significant associated morbidity. Diagnosis in these patients can be challenging due to non-specific symptomatology, lack of specific[...]

Methods and materials: A manual search for patients with TKJRs undergoing USGSB or USGJA was performed using our single institution’s CRIS system over a 27 month period (April 2014-July 2016 inclusive). Patients suffering from early-onset infection (<3 months post-TKJR) and acute infection (hot, red swollen joint) were[...]

Results: Following exclusions, 66 ultrasound guided synovial biopsies and 79 ultrasound guided joint aspirations were performed in a total of 120 patients with cPJI as an indication. 16 (24%) of the synovial biopsy samples and 20 (25%) of the aspiration samples yielded positive microbiology with the most com[...]

Conclusion: In this small retrospective study, USGSB appears to be at least as sensitive for cPJI as USGJA. It may be particularly useful in patients in whom CRP is low and no joint effusion is present. A higher rate of positive microbiology on subsequent revision surgery may indicate that USGSB has a higher po[...]

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References: Moran E, Byren I, Atkins BL.  The diagnosis and management of prosthetic joint infections. J Antimicrob Chemother. 2010 Nov; 65 Suppl 3:iii45-54.   Sitt JCM, Griffith JF, Wong P. Ultrasound-guided synovial biopsy. The British Journal of Radiology 2016 89:1057 .   Tande [...]

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